Regulation and Licensing Department



Regulation and Licensing Department

NEW MEXICO REAL ESTATE COMMISSION

5500 San Antonio Dr. NE, Suite B

Albuquerque, New Mexico 87109

(505) 222-9824

REAL ESTATE BROKER’S ADDITIONAL LICENSE APPLICATION

FOR FEE CALL THE R.E. COMMISSION OFFICE/LICENSING DEPT

______________________________________________________ ______________________________________

1. APPLICANT NAME Individual Tax ID Number

_____________________________________________________________ _______________________________

RESIDENCE LOCATION (DO NOT USE PO BOX) PHONE #

______________________________________________________ ______________________________________

RESIDENCE MAILING ADDRESS (IF DIFFERENT) DATE OF BIRTH

______________________________________________________________________________________________

CITY STATE ZIP CODE

E-MAIL ADDRESS:_______________________________________________________________________________

Indicate the status you are seeking (select only one): _____ Associate Broker _____ Qualifying Broker

==============================================================Please select all that apply and provide company information below:

New Company/or location_____ Existing Company____ & Property Management: yes /no

______________________________________________________________________________________________

CORPORATION NAME

______________________________________________________________________________________________

TRADE NAME/DBA

__________________________________________________________ __________________________________

BUSINESS LOCATION (STREET NAME AND NUMBER) BUSINESS PHONE NO.

______________________________________________________________________________________________

BUSINESS MAILING ADDRESS (IF DIFFERENT)

______________________________________________________________________________________________

CITY STATE ZIP CODE

==============================================================

I hereby certify that all of the information contained in this completed form is true and correct to the best of my knowledge and belief.

__________________________________________ _______________________________________________________

SIGNATURE OF APPLICANT SIGNATURE OF QUALIFYING BROKER (License # if applicable)

_______________________________________ ____________________________________________________

SIGNATURE OF PARTNERS/OWNERS SIGNATURE OF AUTHORIZED CORPORATE OFFICER

REVERSE SIDE OF THIS FORM MUST BE COMPLETED

REVISED 03/18

Do you have an errors and omissions insurance policy? (Attach Copy)

YES [_____] NO [_____]

Insurance Co. Name:___________________________________________________

Effective Date:_______________________ Expiration Date:__________________

==============================================================

TO: NEW MEXICO REAL ESTATE COMMISSION

CONSENT TO EXAMINE AND AUDIT

I, ___________________________, being a licensed New Mexico real estate broker or broker applicant hereby authorize the New Mexico Real Estate Commission or its authorized representative to examine and audit the trust, trustee, or escrow account maintained by me pursuant to Section 61-29-12 (11) N.M.S.A. 1978 Compilation, and the Commission rules regarding such trust, trustee, or escrow accounts and further authorize any bank or recognized depository to permit such examination and audit. This consent and authorization is made personally and/or corporately.

______________________________________

Signature of applicant

REVISED 03/18

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