STATE OF NEVADA

[Pages:2]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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