STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE Serving Californians Since 1917 BRANCH OFFICE APPLICATION RE 203 (Rev. 6/12) DRE RECEIVED DATE LICENSE TYPE — Check one only INDIVIDUAL BROKER LICENSE (Complete items 1 & 3–5.) CORPORATION OFFICER LICENSE (Complete items 2–5.) 9 Read instructions on reverse side before completing. 9 Type or print clearly in blue or black ink. 1. BROKER ID NO. INDIVIDUAL BROKER NAME — DO NOT LIST DBAs OR TRACT NAMES 2. CORPORATION ID NO. EFF. DATE (FOR DRE USE ONLY) CORPORATION NAME — DO NOT LIST DBAs OR TRACT NAMES NAME OF LICENSED BROKER-OFFICER 3. MAILING ADDRESS — STREET ADDRESS OR POST OFFICE BOX CHANGE OF MAILING ADDRESS? YES CITY 4. STATE MAIN OFFICE ADDRESS — STREET ADDRESS CHANGE OF MAIN ADDRESS? YES CITY STATE A. CHECK ONE A D ADD CANCEL NO ZIP CODE NO ZIP CODE BRANCH OFFICE(S) BRANCH OFFICE ADDRESS – STREET ADDRESS (DO NOT LIST DBAs OR TRACT NAMES) 2ND LINE OF ADDRESS, IF ANY CITY ZIP CODE CA B. CHECK ONE A D ADD CANCEL BRANCH OFFICE ADDRESS – STREET ADDRESS (DO NOT LIST DBAs OR TRACT NAMES) 2ND LINE OF ADDRESS, IF ANY CITY ZIP CODE CA C. CHECK ONE A D ADD CANCEL BRANCH OFFICE ADDRESS – STREET ADDRESS (DO NOT LIST DBAs OR TRACT NAMES) 2ND LINE OF ADDRESS, IF ANY CITY ZIP CODE CA D. CHECK ONE A D ADD CANCEL BRANCH OFFICE ADDRESS – STREET ADDRESS (DO NOT LIST DBAs OR TRACT NAMES) 2ND LINE OF ADDRESS, IF ANY CITY ZIP CODE CA E. CHECK ONE A D ADD CANCEL BRANCH OFFICE ADDRESS – STREET ADDRESS (DO NOT LIST DBAs OR TRACT NAMES) 2ND LINE OF ADDRESS, IF ANY CITY ZIP CODE CA 5. ORIGINAL SIGNATURE OF INDIVIDUAL BROKER OR LICENSED BROKER-OFFICER »» DRE ONLY PROCESSOR # DATE PROCESSED DATE SENDER'S # BUSINESS PHONE NO. — INCLUDE AREA CODE DATE SENT American LegalNet, Inc. www.FormsWorkFlow.com RE 203 — Reverse General 9 Individual Brokers — Complete items #1 and 3–4 plus the DSSURSULDWH QXPEHU RI EUDQFK RI¿FH DGGUHVV EORFNV 9 Corporations — Complete items #2–4 plus the appropriate QXPEHU RI EUDQFK RI¿FH DGGUHVV EORFNV 9 Signature — Line #5 must be signed by the broker or licensed EURNHURI¿FHU RI WKH FRUSRUDWLRQ 9 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. 9 $ EUDQFK RI¿FH OLFHQVH FDQQRW EH LVVXHG WR D 32 %R[ Add or Cancel License ,I \RX KROG DQ LQGLYLGXDO EURNHU OLFHQVH DQG D FRUSRUDWLRQ RI¿FHU license, indicate which license the add/cancel request should apply. 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