Texas
|Form 3102 |[pic] |This space reserved for office use. |
|(Revised 03/15) |Membership Camping Resort | |
| |Sales Person or Contract-Broker Registration Application | |
|Submit to: | | |
|Secretary of State | | |
|Registrations Unit | | |
|P.O. Box 13550 | | |
|Austin, TX 78711-3550 | | |
|512 475-0775 | | |
|FAX: 512 475-2815 | | |
|Filing Fee: $50.00 | | |
I am applying for: (please circle one) SALESPERSON CONTRACT-BROKER
1. Name of Applicant:__________________________________________________________________
2. Residence Address:_________________________________________________________________
____________________________________________________________________________________
3. Telephone Numbers: Home ( )__________________ Business ( )___________________
4. Business Address:____________________________________________________________________
____________________________________________________________________________________
5. Name of Employer: (if applicable)_____________________________________________________
6. Address of Employer:(if applicable)___________________________________________________
_____________________________________________________________________________________
7. Have you ever been convicted of a felony or a misdemeanor involving moral turpitude?
_________ Yes _________No
8. If you answered yes to Question 7, describe the nature of the crime, when and where it was committed, and the disposition of the conviction.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
9. Have you been refused a real estate broker's or salesperson's license, or any other occupation license in this or any other state?
________Yes ________ No
10. If you answered yes to Question 9, explain fully the circumstances of the refusal.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
11. Has your license as a real estate broker or salesperson in this or any other state ever been revoked or suspended?
_______ Yes ________ No
12. If you answered yes to Question 11, explain fully the circumstances of the denial or suspension.
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I certify (or declare), under penalty of perjury, that I have read the foregoing registration and that all the answers are true and correct. Further, I understand and agree that any misstatements of a material fact in this application may result in suspension or revocation of my registration with the State of Texas.
____________________________________________
Signature of Applicant
************************************************************
RETURN THIS APPLICATION WITH THE $50.00 FILING FEE TO:
SECRETARY OF STATE
REGISTRATIONS UNIT
P. O. BOX 13550
AUSTIN, TX 78711-3550
FOR DELIVERY:
JAMES EARL RUDDER OFFICE BUILDING
1019 BRAZOS
AUSTIN, TX 78701
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