STATE OF NEVADA
STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033 e-mail: realest@red. *
TIME SHARE SALES AGENT LICENSE CHANGE
(NRS 119A.220)
Payments to the Nevada Real Estate Division are accepted in the form of credit card, check, money order, cashier check (made payable to the NRED) or exact change.
LICENSE NUMBER: Name of Sales Agent
(Obtain number from NRED website or SS#) First and Last name
DATE:
Residence address (for division use only. Not made public)
Email address (for division use only.)
Phone number (for division use only.)
1. $25.00 - PERSONAL NAME CHANGE: Attach your original license and legal proof of name change. [ie: proof may
consist of copies of a marriage certificate, divorce decree, or court order.]
From: First
To: First
Middle
Last
Middle
Last
2. $25.00 - EMPLOYER CHANGE: Termination and original license must be present at the division or accompany this
form)
Project name :_______________________________________________________________________________________________
Name of Developer:__________________________________________________________________________________________
Location Address: ___________________________________________________________________________________________
No & Street
City
State
Postal code
3. APPLICANT'S SIGNATURE:
X Signature of Applicant
# Broker or Broker Salesperson office mgr license # Real Estate Brokerage - Firm Name
4. BROKER AFFIDAVIT:
In accordance with NRS 119A, I acknowledge that I am responsible for the Timeshare sales, inducing, and soliciting activities of the above named time share Agent as long as they are employed by me. I declare that within 10 days, I will notify the Nevada Real Estate Division of any change in association or location.
(Please Print) Name of Project Broker or Broker Salesperson office manager X Signature of Project Broker or Broker/Salesman Office Mgr
Revised: 03/20/2017
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STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033 e-mail: realest@red. *
5. REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE Pursuant to NRS 353C.1965 All applicants MUST complete this section. Please select ONE option.
I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance with the provisions of NRS Chapter 76. My Nevada business license number is: _______________________________________
I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the provision of NRS Chapter 76 and my application is pending.
I do NOT have a Nevada business license number. The Real Estate Division is not the arbiter of determining whether the applicant needs a business license. Information about the Nevada business license can be found on the Secretary of State's website at:
Division only: Receipt #___________________ Date: ____________________ Initials: _________________
Revised: 03/20/2017
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