REAL ESTATE INDIVIDUAL OR ASSOCIATE BROKER LICENSE …

Bureau of Professional Licensing

PO Box 30670 ¡ñ Lansing, MI 48909

Telephone: (517) 241-9288

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REAL ESTATE INDIVIDUAL OR ASSOCIATE BROKER

LICENSE OR RELICENSURE APPLICATION

(This Form Should NOT Be Used For License Renewal)

Authority: 1980 PA 299, MCL 338.3434a

Legal Name (First, Middle, Last)

Date of Birth

Address

City

U.S. Social Security Number

State

Permanent I.D. Number (Relicensure only) Telephone Number

Zip Code

E-mail Address

I have the ability and will serve the public in a fair, honest and open manner. If I have had a judgment of guilt in a criminal proceeding or a civil action against

me, I am rehabilitated or the substance of my former offense is not reasonably related to the occupation or profession for which I am seeking a license.

Yes

No

Complete this question for relicensure only: Do you have any unsatisfied penalties or conditions imposed by disciplinary action in this state or any other

jurisdiction?

Yes

No

Have you ever been convicted of embezzlement or misappropriation of funds?

Yes

No

If you have been convicted of embezzlement or misappropriation of funds, pursuant to MCL 339.2505(2) you cannot be licensed as a Broker in this profession.

Will you be working as an Associate Broker under an employing Broker, or will this license be used as an Individual Broker (sole proprietorship)?

Note: If you are forming or plan on working for a limited liability company or corporation, you must select Associate Broker.

Associate Broker (Working under an employing broker )

Individual Broker (Sole Proprietorship)

CHECK THE LICENSE TYPE

FOR OFFICE USE ONLY

New Applicant ¨C Armed Forces Veteran (choose type below; see required additional documents)

Associate or Individual Broker

License Number

Issue Date

Fee Waived

If applying between 7/2/2018 and 10/31/2019:

Associate or Individual Broker

New

$143.00 6502-02 = $113.00

6502-15 = $ 15.00

6502-16 = $ 15.00

Relicensure

If applying between 11/1/2019 and 10/31/2020 :

Associate or Individual Broker

New

$ 107.00 6502-02 = $ 87.00

6502-15 = $ 10.00

6502-16 = $ 10.00

Relicensure $ 127.00

6502-06 = $ 107.00

6502-15 = $ 10.00

6502-16 = $ 10.00

If applying between 11/1/2020 and 7/1/2021:

Associate or Individual Broker

New

$71.00 6502-02 = $ 61.00

6502-15 = $ 5.00

6502-16 = $ 5.00

Relicensure

6502-06 = $ 81.00

6502-15 = $ 5.00

6502-16 = $ 5.00

$163.00

$91.00

6502-06 = $133.00

6502-15 = $ 15.00

6502-16 = $ 15.00

Reissue Broker License in Same 3-year License Cycle

Associate or

Individual Broker

6502-32 = $ 10.00

Real Estate Licenses expire on 10/31/2021

Make your check or money order in U.S. currency payable to: STATE OF MICHIGAN

FEES ARE AUTHORIZED BY THE STATE LICENSE FEE ACT, 1979 PA 152, AND ARE NOT REFUNDABLE.

BPL/REBRKRAPPL (Rev. 10/19)

The Department of Licensing and Regulatory Affairs will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability, or

political beliefs. If you need assistance with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency.

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New Employing Broker Name (This does not apply to Individual Broker applicants.)

Business Address

Employing Broker Permanent I.D. Number (if applicable)

City

Telephone Number

State

MI

Zip Code

E-mail Address

Assumed Name (if applicable)

Will you be the Principal for this Employing Broker? (This does not apply to Individual Broker applicants)

Yes

No

Have you passed the required examination? (if applicable)

Yes

No

N/A

Have you completed 90 hours of approved prelicensure education? (if applicable)

Note: Possession of a law degree is considered equivalent to 60 clock hours of real estate education with 6 hours in civil rights law and fair housing law.

Possession of a master¡¯s degree in business administration or finance from a degree or certificate granting public or independent nonprofit college or

university, junior college, or community college is considered equivalent to 60 clock hours of real estate education. Possession of a bachelor¡¯s degree in

business or finance from a degree or certificate granting public or independent nonprofit college or university, junior college, or community college is

considered equivalent to 30 clock hours of real estate education.

Yes

No

N/A

Do you have the equivalent of 3 years of full-time experience in the business of real estate or in a field determined by the Department to be relevant and

related to the business of real estate as outlined in MCL 339.2505(7)? (New applicant must complete & submit the Verification of Real Estate Experience for a

Broker License)

Yes

No

Applicants whose license has been expired MORE than 3 years, must choose one of the following:

Exam: Contact the Department upon passing the exam.

Submit a copy of approved 90-hour prelicensure course completion certificate.

Submit proof of completion of six (6) hours of real estate continuing education for each year and partial year missed since the expiration date of the

license. At least 2 hours for each year must involve law, rules, and court cases regarding real estate.

Applicants whose license has been expired LESS than 3 years:

? Must complete six (6) hours of real estate continuing education for each year and partial year missed since the expiration date of the license pursuant to

MCL 339.2502a(4). At least 2 hours for each year must involve laws, rules, and court cases regarding real estate. Do not submit completion certificates;

they must be retained for at least 4 years. The licensee shall produce the record that contains that evidence at the request of the department.

Required Additional Documents

? Non-Michigan residents must submit a Consent to Service of Process. (This form may be found under License Applications & Forms at

realestate.)

? If requesting a fee waiver as an individual who served in the armed forces - form DD214, DD215, or any other form acceptable to the Department that

demonstrates you were separated from service with an honorable character of service or under honorable conditions (general) character of service.

Certification

I certify that the statements in this document are true and complete. I understand that any omitted statement, misrepresentation, or fraud may be cause for

denial of my application, disciplinary action, or may be punishable by law. I agree the Department is required by law to obtain my social security number

pursuant to MCL 338.3434a. Further, if I am applying for relicensure and sign below, I certify that I have completed the required number of continuing

education hours pursuant to MCL 339.2502a.

Signature

Date

BPL/REBRKRAPPL (Rev. 10/19)

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VERIFICATION OF REAL ESTATE EXPERIENCE FOR A BROKER LICENSE

(For New/First Time Broker Applicants Only)

Indicate your experience, pursuant to MCL 339.2505(7) and R 339.22217, below, by checking the appropriate box(es) and listing the

corresponding information in the application table.

(i) Real Estate License: One year of credit for each 12-month

period of licensure in which he/she closed 5 or more real

estate transactions. (MUST SHOW THREE (3) SEPARATE

YEARS.)

Worked from ¨C To (month/year)

# of Transactions

(iii) Investor: Six months of credit for each 5 real property

transactions personally negotiated for a purchase or sale by

the individual for his/her own account, with a maximum of 1

year of credit allowed. However, an individual shall not

receive credit under this subdivision if he/she engaged in

more than 5 sales in any 12-month period in violation of

section 2502b.

Worked from ¨C To (month/year)

# of Transactions

(v) Property Management: 1 year of credit for managing at least

10 units, located in the state of Michigan, for 3 or more years.

(Maximum total credit of 1 year can be earned for this

activity)

Managed from ¨C To (month/year)

(ii) Builder: One year of credit for each 12-month period in

which he/she built and personally sold or leased at least

5 residential units, commercial units, or industrial units or

a combination of those types of units.

Worked from ¨C To (month/year)

# of Units

(iv) Land or condominium developers: 1 year of credit for

each 2 developments or subdivisions that contain at least

10 units or parcels that he or she bought, subdivided, and

improved for sale as lots or dwellings.

Worked from ¨C To (month/year)

# of Units

(vi) Real Estate Appraiser licensed under article 26: One year

of credit for each period equivalent to at least 40 hours per

week, and at least 48 weeks per year, in which he/she

acted as a real estate appraiser.

Number of periods worked equivalent to 40 hours per week, 48

weeks per year:

# of units

(vii) Attorneys: 1 year of credit for each year in which he/she acted as the attorney for at least 6 real estate transactions.

Worked from ¨C To (month/year)

# of Real Estate Transactions

(viii) Related Occupations: One year of credit for each period equivalent to at least 40 hours per week, and at least 48 weeks per year, in

which the individual worked in a capacity directly related to the acquisition, financing, or conveyance of real estate, or in a position in

which the individual was directly involved in a real estate business, including serving as the decision-making authority in any of the

following positions:

# of periods worked equivalent

Check applicable box(es) and answer corresponding questions.

to 40 hours/wk, 48 wks/year

(A)

A loan or trust officer in a federal or state-regulated depository institution.

(B)

A loan or trust officer in a mortgage company.

(C)

A real estate officer of a corporation which is not a licensed real estate broker.

(D)

A title insurance company officer engaged in the closing of escrow accounts and real

estate closings.

I certify that the statements in this document are true and complete. I understand that any omitted statement, misrepresentation, or fraud may

be cause for denial of my certificate, disciplinary action, or may be punishable by law.

Applicant¡¯s Signature

Date

Applicant¡¯s Printed Name

BPL/REBRKRAPPL (Rev. 10/19)

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