STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE CORPORATION LICENSE APPLICATION DRE USE ONLY DRE USE ONLY DRE RECEIVED DATE GENERAL INFORMATION This application may be used to license: Read Sections III and IV before completing this application. appropriate fee must SECTION I 227 CORPORATION INFORMATION 1A. DOES THIS CORPORATION CURRENTLY HOLD OR HAS IT PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA? YES IF YES, COMPLETE ITEMS 1B - 4D. NO IF NO, COMPLETE ITEMS 2A - 4D DRE USE ONLY 1B. DRE CORPORATION LICENSE NUMBER 1C. EXPIRATION DATE 2A. CORPORATION NAME (PRINT NAME AS IT APPEARS ON CERTIFICATE OF STATUS, DO NOT LIST FICTITIOUS BUSINESS NAMES.) 2B. CALIFORNIA SECRETARY OF STATE IDENTIFICATION NUMBER (REFER TO PAGE 5) 2C. FEDERAL TAXPAYER IDENTIFICATION NUMBER (REQUIRED - SEE PRIVACY NOTICE) 3A. MAILING ADDRESS (STREET ADDRESS OR POST OFFICE BOX) 3B. CITY 3C. STATE 3D. ZIP CODE 4A. MAIN OFFICE ADDRESS (STREET ADDRESS - MUST BE A PHYSICAL ADDRESS) 4B. CITY 4C. STATE CA 4D. ZIP CODE 5. FICTITIOUS BUSINESS NAME (IF ANY) 226 ATTACH A COPY OF THE FICTITIOUS BUSINESS NAME STATEMENT AS FILED WITH THE COUNTY CLERK. SECTION II 227 BROKER-OFFICER INFORMATION 6A. DO YOU CURRENTLY HOLD OR HAVE YOU PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA? YES IF YES, COMPLETE ITEMS 6B - 11. NO IF NO, COMPLETE ITEMS 7 - 11 6B. LICENSE IDENTIFICATION NUMBER 6C. TYPE OF LICENSE 6D. EXPIRATION DATE OF LICENSE 7. NAME OF BROKER-OFFICER (LAST, FIRST & MIDDLE) 8. SOCIAL SECURITY NUMBER OR INDIVIDUAL TAXPAYER ID NUMBER (REQUIRED-SEE PRIVACY NOTICE) 9. BIRTH DATE (MM/DD/YYYY) 10. CORPORATE OFFICER TITLE 11. TYPE OF BROKER-OFFICER LICENSE REQUESTED: (CHECK ONE) REFER TO FEE SECTION ON PAGE 6. DESIGNATED BROKER-OFFICER ADDITIONAL BROKER-OFFICER (Refer to Fees.) SUBSTITUTION OF CURRENT DESIGNATED BROKER-OFFICER (Refer to page 5, Section II Instructions, #11.) DRE USE ONLY RESTRICTED LICENSE CORPORATION OFFICER FINGERPRINTS RECEIVED NOT NEEDED FLAG CLEARANCE VIOLATIONS CLEARANCE REC'D DOJ FBI RAP REC'D DOJ FBI NOTES EXAM ID NUMBER PROCESSOR # & DATE PROCESSED LICENSE EFFECTIVE DATE LICENSE EXPIRATION DATE American LegalNet, Inc. www.FormsWorkFlow.com BROKER-OFFICER INFORMATION (CONTINUED) 12. DO YOU RESIDE IN THE STATE OF CALIFORNIA? YES NO IF NO, THEN A CONSENT TO SERVICE OF PROCESS (RE 234) MUST ALSO BE COMPLETED. (Refer to #12 instruction on page 5.) 13. ARE YOU CURRENTLY SERVING IN THE U.S. MILITARY? YES NO 14A. HAVE YOU PREVIOUSLY SERVED IN THE U.S. MILITARY? 14B. IF YES, WERE YOU HONORABLY DISCHARGED? YES NO YES NO (See page 6 for expedited processing instructions) 15. CURRENT PHONE NUMBER (REQUIRED) ( ) 16. CURRENT EMAIL ADDRESS (REQUIRED - PRINT CLEARLY) 17. BUSINESS TELEPHONE NUMBER ( ) 18. BUSINESS CELL PHONE NUMBER ( ) 19. HAVE YOU EVER USED ANY OTHER NAMES (i.e., MAIDEN NAME, AKA, ETC.)? 20. GENDER YES IF YES, LIST NAMES USED: NO MALE FEMALE BACKGROUND INFORMATION Carefully read and provide detailed answers to questions 21-26. You must provide a "yes" or "no" response to all questions, and completely and accurately provide the detailed information required. Attach additional sheets if you need more space. Each additional sheet must be signed by the applicant. Failure to disclose pertinent information may result in denial of your license application and/or delays. "Convicted" as used in question 21 below includes:225 All state, commonwealth, possession, or federal misdemeanor and felony convictions, and all military and foreign convictions.225 A verdict of guilty by judge or jury, a plea of guilty, a plea of nolo contendere (or "no contest"), or a forfeiture of bail in the courts.225 Convictions expunged under Penal Code sections 1203.4, 1203.4a and 1203.41 or equivalent non-California statute must still be disclosed. Proof that a conviction has been expunged under Penal Code sections 1203.4, 1203.4a and 1203.41 must be submitted with the application. 225 Convictions must be disclosed no matter how long ago they occurred and whether the convicted person was a minor (under 18 years of age, if tried as an adult). Exceptions to "Convicted": DO NOT DISCLOSE225 Any Juvenile Court adjudication.225 Any conviction sealed under Penal Code section 1203.45 or Welfare and Institutions Code section 781.225 Any conviction under Health and Safety Code section 11357(b), (c), (d), or (e), or Health and Safety Code section 11360(b) AFTER at least two years have passed since the date of the conviction. 21.HAVE YOU EVER BEEN CONVICTED (SEE PARAGRAPH ABOVE) OF ANY VIOLATION OF THE LAW AT THE MISDEMEANOR OR FELONY LEVEL? IF YES, COMPLETE ITEM 27 WITH INFORMATION ON EACH CONVICTION........................................................................................................................................ YES NO 22.ARE THERE CRIMINAL CHARGES PENDING AGAINST YOU AT THIS TIME, OR ARE YOU CURRENTLY AWAITING JUDGMENT AND SENTENCING FOLLOWING ENTRY OF A PLEA OR JURY VERDICT? IF YES, COMPLETE ITEM 27........................................................................................................................... YES NO 23.HAVE YOU EVER HAD A DENIED, SUSPENDED, RESTRICTED OR REVOKED BUSINESS OR PROFESSIONAL LICENSE (INCLUDING REAL ESTATE), IN CALIFORNIA OR ANY OTHER STATE? IF YES, COMPLETE ITEM 28............................................................................................................................ YES NO 24.ARE THERE ANY LICENSE DISCIPLINARY ACTIONS PENDING AGAINST A BUSINESS OR PROFESSIONAL LICENSE YOU HOLD AT THIS TIME? IF YES, COMPLETE ITEM 28................................. YES NO 25.HAVE YOU EVER BEEN REQUIRED TO REGISTER AS A SEX OFFENDER PURSUANT TO THE PROVISIONS OF SECTION 290 OF THE CALIFORNIA PENAL CODE OR ANY COMPARABLE LAW OF ANY STATE OR GOVERNMENTAL UNIT? IF YES, COMPLETE ITEM 29....................................................... YES NO 26.HAVE YOU EVER BEEN ORDERED TO CEASE, DESIST AND/OR REFRAIN FROM DOING AN ACT(S), OR FROM VIOLATING A LAW, RULE OR REGULATION BY, OR CITED FOR A BREACH OF ETHICS OR UNPROFESSIONAL CONDUCT, BY AN ADMINISTRATIVE AGENCY OR PROFESSIONAL ASSOCIATION IN CALIFORNIA OR ANY OTHER STATE? IF YES, COMPLETE ITEMS 28-29................................................ YES NO CONVICTION DETAILS 27. DETAILED EXPLANATION OF ITEM 21 AND/OR 22. COMPLETE ONE LINE FOR EACH VIOLATION AND PROVIDE EXPLANATION BELOW. IF YOU ARE UNABLE TO PROVIDE THIS INFORMATION, PROVIDE ALL THE REQUESTED INFORMATION YOU CAN OBTAIN, WITH AN EXPLANATION FOR THE MISSING INFORMATION. IF THE CONVICTION STATUS HAS BEEN SUBSEQUENTLY CHANGED OR REDUCED, NOTE THAT FACT IN THE AREA PROVIDED FOR ADDITIONAL INFORMATION. ATTACHMENTS FOR ADDITIONAL INFORMATION SHOULD SPECIFY WHICH LINES YOU ARE REFERRING TO. EACH ADDITIONAL SHEET MUST BE SIGNED BY APPLICANT. * CODE SECTION VIOLATED (i.e., 1014, 484, ETC.) ** CODE VIOLATED (i.e., VEHICLE CODE, PENAL CODE, ETC.) *** DISPOSITION (i.e., PROBATION, PAROLE, FINE, PENDING, ETC.) COURT OF CONVICTION (Name and Address) ARRESTING AGENCY (Name and Address) DATE OF CONVIC - TION TYPE OF CONVICTION * CODE SECTION VIOLATED ** CODE VIOLATED *** DISPOSITION CASE NUMBER Example: Sacramento Cnty. 456 Main St., Sac Sacramento City Police 123 Main St., Sac 2/20/87 Felony Misdemeanor 484 Penal Code 6 months probation 1234 27A. Felony Misdemeanor 27B. Felony Misdemeanor 27C. Felony Misdemeanor American LegalNet, Inc. www.FormsWorkFlow.com BACKGROUND INFORMATION (CONTINUED) 28. DETAILED EXPLANATION OF ITEM 23, 24 AND/OR 26. IF NEEDED, EXPLANATION MAY BE PROVIDED BELOW. 28A. TYPE OF LICENSE 28B. LICENSE ID NO. 28C. LICENSE EXPIRATION DATE 28D. STATE 28E. ACTION (revoked, etc.) 28F. DATE OF ACTION 28G. DATE ACTION TERMINATED 28H. CODE SECTION VIOLATED 29. ADDITIONAL INFORMATION: SPECIFY WHICH LINES YOU ARE REFERRING TO. ATTACH EXTRA SHEETS IF MORE ROOM IS NEEDED. EACH ADDITIONAL SHEET MUST BE SIGNED BY APPLICANT. OFFICER CERTIFICATION cannot refund the fees 30. SIGNATURE OF BROKER-OFFICER APPLICANT (MUST BE ORIGINAL SIGNATURE)31. DATE 32. TYPED NAME OF SIGNER American LegalNet, Inc. www.FormsWorkFlow.com SECTION III 227 REGULATION 2746 CERTIFICATION 33. CORPORATION NAME 34. SIGNATURE OF BROKER-OFFICER APPLICANT (MUST