RE 214 (Rev. 5/15) This form is to be used by salespersons only. Broker associates must use RE 204. Read instructions on reverse side before completing. Note: License changes with an asterisk may be completed on-line by utilizing eLicensing. (Refer to information on page 2.) 1. liCenSe iDentifiCation numBer CalBRe Use only CalBRE RECEIVED DATE Type of Change [Check appropriate box(es)] SponSoring Broker/Corp.* employment DiSContinueD perSonal name mailing aDDreSS* telephone/email aDDreSS* aCtivation* sAlEspERson InfoRmATIon 2. SaleSperSon name -- As it AppeArs on liCense. -- laSt, firSt, miDDle, SUFFIX 3. SaleSperSon new name (if ChAnging) -- laSt, firSt, miDDle, SUFFIX (See inStruCtionS on reverSe SiDe; Sign line #11 with new name.) 4. SaleSperSon mailing aDDreSS -- Street aDDreSS/p.o. Box, City, State, Zip CoDe 5. Do you reSiDe in California? yeS no Month if no, an "re 234" muSt Be on file with thiS Bureau. See reverSe SiDe. 7. Current telephone numBer 8. Current email aDDreSS 6. SaleS. liCenSe expiration Date DAy yeAr ( ( ) 10. BuSineSS telephone numBer 9. BuSineSS Cell phone numBer ) CalBRe Use only SaleSperSon Change appliCation CalBRe Use only State of California Bureau of real eState ( ) salespeRson CeRTifiCaTion i hereby Certify thAt A) the inforMAtion on this forM is true AnD CorreCt to the best of My knowleDge, b) i hAve CoMplieD with �10161.8(C) AnD (D) of the business AnD professions CoDe, AnD C) i hAve given notiCe of terMinAtion of eMployMent to the broker iDentifieD on line #20. 11. Signature of SaleSperSon -- Must be originAl signAture Date nEw sponsoRIng BRokER/CoRpoRATIon InfoRmATIon 12. Broker/Corporation iD no. CalBRe Use only 13. SaleSperSon employment Date CalBRe Use only 14. Broker/Corporation name -- as iT appeaRs on liCense; no DBa's 15. main offiCe aDDreSS of Broker/Corp. -- Street aDDreSS, City, State, Zip CoDe employing BRokeR CeRTifiCaTion i hereby Certify thAt A) the Above inforMAtion is true AnD CorreCt to the best of My knowleDge, AnD b) there is A written AgreeMent with this sAlesperson on file in My offiCe As requireD by �2726 of the CoMMissioner's regulAtions. 16. Signature of new Broker/liCenSeD offiCer -- Must be originAl signAture, not photoCopy, etC. Date 17. printeD name of #16 Signer 18. Broker/Corp. expiration Date 19. BuSineSS telephone numBer foRmER BRokER/CoRpoRATIon InfoRmATIon 20. Broker/Corporation iD no. 21. Date SaleSperSon employment DiSContinueD 22. Broker/Corporation name -- as iT appeaRs on liCense; no DBa's 23. Signature of former Broker/liCenSeD offiCer Date CalBRE UsE only proC. # Date proCeSSeD SenDer'S # Date Sent form letter/CommentS DoCument Date uSeD & type (circle one) rD aD kD American LegalNet, Inc. www.FormsWorkFlow.com RE 214 -- Reverse Try elicensing Use eLicensing for expedited processing of your change. Renewal information is posted immediately on CalBRE's public information. Licensees can perform the following transactions using the eLicensing system at www.calbre.ca.gov: � Brokerandsalespersonrenewals � Licensecertificateprints � Salespersonadditions/changesofemployingbroker � Brokerdiscontinuationofsalespersonemployment � Mailingaddress,telephoneandemailaddresschanges � Brokermainofficeaddressaddition/changes � Automatedfeepaymentandprocessing Change of Personal Name � Enter full new name. Attach verificationofnamechange(i.e.,legiblecopyofdriverslicense, marriage certificate, court order, etc.). Sign this form with your new name. Duplicate License � License certificates can be printed online anytime using eLicensing. Mailing Address�Themailingaddress(post office box, residence or business address) is used to mail correspondence to you. If your mailingaddressisthatofyourbroker,pleasenote"c/o"(in care of) your sponsoring broker or corporation. Non-California Residents � If residing outside the State of California, a Consent To Service Of Process (RE 234) is also required,ifnotalreadyonfile. mailing information Thisapplicationmaybesubmittedinpersonatanydistrictoffice ormailedtotheSacramentooffice. Mail To: Bureau of Real Estate P.O.Box137003 Sacramento,CA95813-7003 general information Type or print clearly in ink (black or blue; do not use red). Receipt of this form will not be acknowledged. Business and license mailing addresses are public information and as such are posted on the Internet and available from CalBRE via telephone and written requests. Please consider this when identifying a license mailing address. If you electronically re-create this form to facilitate completion onacomputer,theformshouldnotbealteredinanymanner. Todoso,couldresultindisciplinaryaction.Also,pleasemake certain you do not delete any preprinted information and are using the latest version of the form. Type of Change Check the appropriate box(es) on page 1 and complete the item numbers listed below. Mailingaddress...................................#1�11 Telephoneoremailaddress.................#1�11 Personal name ...................................... #1�11 Activation ............................................ #1�19 Sponsoringbroker ............................... #1�19(required) & 20-23 (optional) Employment discontinued by broker... #1,2,and20-23 Employment discontinued by sales. .... #1,2,4-11,&20-22 PRIVACY INFORMATION: Section1798.17oftheCivilCoderequiresthisnoticebeprovidedwhen collectingpersonalorconfidentialinformationfromindividuals.Each individual has the right to review personal information maintained by thisAgency,unlessaccessisexemptedbylaw. BureauofRealEstate ManagingDeputyComm.IV 1651ExpositionBlvd. Licensing,Examinations,&Education Sacramento,CA95815 Telephone:877-373-4542 GeneralpowersoftheCommissioner,Sections10050,10071,and 10075oftheBusinessandProfessionsCodeauthorizesthemaintenance of this information. BusinessandProfessionsCodeSections30,31(e)and494.5(d)require each real estate licensee to initially provide to the Bureau 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 note To sponsoring Broker/Corporation Sponsoring Broker/Corporation ID# and Name � If you are licensed both as an individual broker and as an officer of a corporation,entertheappropriateID#andname. � Ifthesalespersonwillbeworkingforyouunderyourindividual license,enterthenameandID#fromthatlicense. � Ifthesalespersonwillbeworkingforyouunderyourcorporation officer'slicense,enterthecorporationnameandID#fromthat license. � DonotlistDBA'sonthisapplicati