Pl Please visit our website at www.com.ohio.gov/real 614|466 - 4100 Fax: 614|644 - 0584 TTY/TDD: 800|750 - 0750 Anne M. Petit , Superintendent REAL ESTATE CHANGE OF BUSINESS ADDRESS Per Ohio Revised Code 4735.13(D), in case of any change of business location, a principal broker shall give notice to the superintendent, on a form prescribed by the superintendent, within thirty days after the change of location, whereupon the superintendent shall issue new licenses for the unexpired period without charge. If a broker changes a business location without giving the required notice and without receiving new licenses that action is prima-facie evidence of misconduct under division (A)(6) of Section 4735.18. This form is interactive. You may, before printing, type your responses directly onto the form. Otherwise, this form must be typewritten or printed legibly in black ink. The company/broker original license must be returned with this application in order for the request to be processed. Incomplete or incorrect applications will be returned for correction. Check this box if you do not have the original company/brokerage license to return and enclose a $25 fee to process this request without the license. APPLICANT FILE NUMBER BUSINESS ENTI T Y NAME BUSINESS DBA NAME COMPANY FILE NUMBER OLD BUSINESS A DDRESS OLD STREET AD D R ESS C I TY COUN T Y STATE Z I P CODE NEW BUSINESS A DDRESS N E W STREET A D DRESS (This Cannot Be a PO Box) BUSINESS PHO N E C I TY COUN T Y STATE Z I P CODE Name of appl i c a n t or principal broker a u th o rized to submit this chang e . (t y pe or pr i nt) Signatu r e o f appl ic ant or principal broker author i z ed to subm i t th i s chang e . Da t e **This application cannot be processed without the return of the original license or the $25 lost license fee to replace the license** REPL-17-0008 COM 3520 Equal Opportunity Employer and Service Provider Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com