STATE OF CALIFORNIADEPARTMENT OF þRREAL þEEþsSTATEBROKER CHANGE þAAPPLIþcCATION (For Broker Licensees)RE 204 (Rev. 7/18) þ This form is to be used by brokers only (including those working as broker-salespersons). Licensed salespersons must RE 204A. þ Read instructions on reverse side before completing. þ Note: License changes with an asterisk may be completed online by using eLicensing. (Refer to information on page 2.)TYPE OF CHANGE [Check appropriate box(es)] Mailing Address* Telephone/Email Address* Personal Name BROKER INFORMATION þc þn þn þf þca þon þmb D þRERE US þEE þONON LY þo þam þLa þSU þI þo þona þam þLa þSU þI D þRERE US þEE þONON LY4 þDo þo þn þa þfo þn þa þIf þan þRE þma þb þS Y þeE S þnN O þo þma þn þa þa þo þpo þoff þc þbox CI þtT Y þStateSTATE ZI þpP COD þeE D þRERE US þEE þONON LY þo þa þn þff þc þS þEn þma þn þa þo þno þb þn þa þo þno þa þb þan CI þtT Y þStateSTATE C þAA ZI þpP COD þeE D þRERE US þEE þONON LY þURRE þT þon þmb þURRE þT þma þa þb þn þc þp þon þn þmb þb þn þp þon þn þmb þc þo þn þam þD þn þa þapp þa þon þf þn þf þom þo þn þDD þR CANCEL þR þE þS þS þD þD þona þc þo þn þam þf þan þDD þR CANCEL12. þOO RIGINA þlL SIGNAT þuU RE OF þBB ROKER ( þII F NAME þcC HANGE HA þsS O þccuCCU RRE þdD , þusUS E NEW þlL EGA þlL NAME.)DATED þRERE US þEE þONON LY þoc CO þmmentMMENT S þDa þoc DR þEE US þEE þONON L þYY D þRERE þRERE C þEIEI V þEE D D þATEATE DR þEE US þEE þONON L þYY American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 InstructionsCheck the appropriate 223change224 box(es) on page 1 and complete all information requested on the application.Change of Personal Name 227 Enter full new name (do not refer to any þfþi Sign line #12 with your new name. If you have a DBA on record, a Fictitious Mailing Address business address) is used to mail correspondence to you.Non-California Residents 227 If residing outside the State of California, a notarized Consent To Service Of Process (RE 234) is also required, if not of-State Broker Acknowledgment (RE 235). 227 Enter the new primary business location. The main must be a California address. If a street address is unavailable, indicate the physical location (i.e., the nearest intersection and the distance to it). If you are no longer working in real estate for which a California license is required, enter 223no business address224 on line #6. No license will be issued unless requested.Fictitious Business Name 227 Do not list your broker222s DBA, if you are working as a broker-salesperson.To add a DBA to your broker license, enter the name exactly as it appears þ site (www.dre.ca.gov) to determine if the name is already in use by another broker. þ FBNS. Refer to Section 2731 of the Commissioner222s Regulations for restrictions. þ þ To cancel a DBA, complete the entire application. Check the cancel box on line #11A and list the DBA you wish to cancel.Mailing InformationMail To: þ Department of Real Estate þ P.O. Box 137004 þ Sacramento, CA 95813-7004 Try eLicensing þ Use eLicensing for expedited processing of your change. þ Licensees can perform the following transactions using the eLicensing system at www.dre.ca.gov: þ þ branch) þ þ þ þ þ þGG eneral Information þ Type or print clearly in ink (black or blue; do not use red). þ Business and license mailing addresses are public information and as such are posted on the Internet and available from DRE via telephone and written requests. Please consider this when identifying a license mailing address. þ If you electronically re-create this form to facilitate completion on a computer, the form should not be altered in any manner. To do so, could result in disciplinary action. Also, please make certain you do not delete any preprinted information and are using the latest version of the form.Broker-Salespersonto the relationship existing between a licensed real estate salesperson and an employing broker.However, such broker-salespersons are still licensed by the Department of Real Estate (DRE) as real estate brokers. Only by written agreement with another broker are they acting as broker-salespersons. Section 2726 of the Commissioner222s Regulations requires that 223205 every real estate broker shall have a written agreement with each of his salesmen, whether licensed as a salesman or as a broker under a broker-salesman arrangement.224Even though a broker may act as a broker-salesperson in a relationship with another broker, for Department of Real Estate licensing and record-keeping purposes the licensee is still a broker. This means that a broker-salesperson should still communicate with DRE using only appropriate broker forms and applications.name of the broker for whom the broker-salesperson works. That type of information is irrelevant as there is no reference in the DRE records that such a working relationship exists. It is also imperative that a broker-salesperson speak for himself or herself, meaning that any requests for record changes be made by the broker-salesperson and not by anyone else on his or her behalf.A broker-salesperson should never use salesperson forms or applications when renewing or making changes to a broker record. Doing so will cause delays in processing whatever is requested. Remember 227 a broker is always a broker regardless of any working relationship that may exist with another broker. þININ S þTRTR UC þTIONTION S PRIVACY INFORMATION: Section 1798.17 of the Civil Code requires this notice be provided when individual has the right to review personal information maintained by this Agency, unless access is exempted by law.Department of Real Estate þ Assistant Commissioner1651 Exposition Blvd. þ Licensing & AdministrationSacramento, CA 95815 þ Telephone: 877-373-4542General powers of the Commissioner, Sections 10050, 10071, and 10075 of the Business and Professions Code authorizes the maintenance of this information.Business and Professions Code Sections 30, 31(e) and 494.5(d) require each real estate licensee to initially provide to the Department of Real Estate his or her social security number which will be furnished to the Franchise Tax Board. The Franchise Tax Board will use your number sections also require that each application for a new license or renewal and the Franchise Tax Board will share taxpayer information with the Department of Real Estate, and that failure to pay tax obligations may result in a suspension or denial of a license. The Board of Equalization and Franchise Tax Board require the Department to collect social purposes of matching the names of the 500 largest tax delinquencies pursuant to Section 7063 or 19195 of the Revenue and Taxation Code. shall not be deemed public records and shall not be open to the public for inspection. The Real Estate Law and the Regulations of the Commissioner require or any part of the required information is not provided, processing may be delayed. In addition, the Commissioner may suspend or revoke a license, or in the case of a license applicant, may deny the issuance for misstatements of facts (including a failure to disclose a material fact) in an application for a license.The information requested in this form is primarily used to furnish license status information to the Department222s Enforcement Section, and to answer inquiries and give information to the public on license status, mailing and business addresses and actions taken to deny, revoke, restrict or suspend licenses for cause.This information may be transferred to real estate licensing agencies in other states, law enforcement agencies (City Police, Sheriff222s Departments, District Attorneys, Attorney General, F.B.I.), and any other regulatory agencies (i.e., Department of Business Oversight, Department of Insurance, Department of Consumer Affairs, California Bar Association). American LegalNet, Inc. www.FormsWorkFlow.com