Real Estate License Application Form - Wa Department Of Licensing
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Real Estate License Application
You can use this form to apply for your first broker or managing broker
For vailidation only
license. You can also use this form to change your name, transfer, reactivate,
or reinstate your license. Send this completed form and any required documents
with a check or money order payable to the Washington State Treasurer, to:
Real Estate Licensing
Department of Licensing
PO Box 9021
Olympia, WA 98507
(360) 664-6500 or (360) 664-6488
Check all that apply:
New license (check one):
Broker – $146.25
Managing broker – $210.00
Reactivation – all applicable fees (contact Real Estate Licensing for fee amount)
Reinstatement – all applicable fees (contact Real Estate Licensing for fee amount)
Fingerprint/ background check, if applicable – $35.25 (see next page)
Transfer – no fee
Name change – no fee
Applicant information
– Incomplete applications will not be processed.
TYPE or PRINT Name (as it appears on your license, if applicable)
Date of birth
Home address
(Area code) Telephone number
City
State
ZIP code
Email
Answer the following
If you answer “Yes” to questions 1-5, attach a letter of explanation. Include the charge, date of conviction, civil judgment
or order, county jurisdiction, state, and disposition of charges.
1. With the exception of motor vehicle violations, have you been convicted of a crime, misdemeanor
or felony, in this or any other state, by the federal government or by any other jurisdiction
within the past ten years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Is there a criminal complaint, accusation, or information presently pending against you or are you
currently under indictment, in this or any other state, by the federal government
or by any other jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3. Has any professional or occupational license, certification, or permit held by you been fined,
suspended, revoked, refused, or denied, in this or any other state, by the federal government
or by any other jurisdiction in the past ten years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
4. Have you ever had a civil court order, verdict, or judgment entered against you in any court
of competent jurisdiction, in this or any other state, by the federal government or by any
other jurisdiction in the past ten years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
5. Are you currently required to register as a sex offender in this state or any other state? . . . . . . . . . . . .
Yes
No
If yes, in which state ___________________ and county
.
__________________________________
6. Do you understand that we, the Department of Licensing (DOL), have the right to enter your
business location(s) at reasonable times to inspect the records that you are required to keep
by the laws and regulations that govern the license you are applying for? . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
7. Do you agree to cooperate with an audit or an investigation by providing DOL with the requested
documents and a written explanation of the matter contained in a complaint? . . . . . . . . . . . . . . . . . . . .
Yes
No
8. Have you submitted a Real Estate Program fingerprint card in the last six years? . . . . . . . . . . . . . . . . .
Yes
No
If no, see next page for fingerprint requirements and instructions.
Certification
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
_______________________________________________________________________
___________________________________________________
Date and place
Applicant signature
RE-620-004 (R/7/10)W Page 1 of 2
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