STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE DRE USE ONLY 5HDO (VWDWH 0$77(56 CORPORATION LICENSE APPLICATION 5(  5HY  DRE RECEIVED DATE OLFHQVHG FRUSRUDWLRQ 25 DRE USE ONLY GENERAL INFORMATION ¾ This application may be used to license: ¾ $ FRUSRUDWLRQ ZLWK D GHVLJQDWHG EURNHURI¿FHU ¾ $Q DGGLWLRQDO EURNHURI¿FHU ZLWK D QHZ RU FXUUHQWO\ ¾ $ &HUWL¿FDWH RI 6WDWXV RU $UWLFOHV RI ,QFRUSRUDWLRQ DQG WKH ¾ $ QHZ RI¿FHU DV D VXEVWLWXWH UHSODFHPHQW IRU WKH H[LVWLQJ GHVLJQDWHG EURNHURI¿FHU ¾ Read Sections III and IV before completing this application. ¾ 7KLV DSSOLFDWLRQ PXVW EH FRPSOHWHG DQG VLJQHG E\ WKH brokerRI¿FHU DSSOLFDQW appropriate fee must DFFRPSDQ\ WKLV IRUP 5HIHU WR 6HFWLRQ ,9 ¾ $Q\ FKDQJHV DGGUHVVHV '%$ HWF WR D FXUUHQWO\ OLFHQVHG FRUSRUDWLRQ PXVW EH VXEPLWWHG RQ D &RUSRUDWLRQ &KDQJH$SSOLFDWLRQ 5( $ SECTION I — CORPORATION INFORMATION 1A. DOES THIS CORPORATION CURRENTLY HOLD OR HAS IT PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA? † NO † YES DRE USE ONLY IF YES, COMPLETE ITEMS 1B AND 1C. 1B. &25325$7,21 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 4) 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 4C. STATE 4D. ZIP CODE 4A. MAIN OFFICE ADDRESS (STREET ADDRESS - MUST BE A PHYSICAL ADDRESS) 4B. CITY CA 5. FICTITIOUS BUSINESS NAME (IF ANY) – ATTACH A COPY OF THE FICTITIOUS BUSINESS NAME STATEMENT AS FILED WITH THE COUNTY CLERK. SECTION II — BROKER-OFFICER INFORMATION 1A. DO YOU CURRENTLY HOLD OR HAVE YOU PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA? † NO † YES IF YES, COMPLETE ITEMS 1B -1D. 1B. LICENSE IDENTIFICATION NUMBER 1C. TYPE OF LICENSE 1D. EXPIRATION DATE OF LICENSE 2. NAME OF BROKER-OFFICER (LAST, FIRST & MIDDLE) 3. SOCIAL SECURITY NUMBER (REQUIRED-SEE PRIVACY NOTICE) 4. BIRTH DATE (MM/DD/YYYY) 5. CORPORATE OFFICER TITLE 6. TYPE OF BROKER-OFFICER LICENSE REQUESTED: (CHECK ONE) REFER TO FEE SECTION ON PAGE 4. † † DESIGNATED BROKER-OFFICER † ADDITIONAL BROKER-OFFICER (Refer to Fees.) SUBSTITUTION OF CURRENT DESIGNATED BROKER-OFFICER (Refer to page 4, Section II Instructions, #6.) DRE USE ONLY RESTRICTED LICENSE … CORPORATION † OFFICER CLEARANCE REC'D … DOJ … FBI EXAM ID NUMBER FINGERPRINTS FLAG CLEARANCE VIOLATIONS † RECEIVED † NOT NEEDED RAP REC'D NOTES … DOJ … FBI PROCESSOR # & DATE PROCESSED LICENSE EFFECTIVE DATE LICENSE EXPIRATION DATE American LegalNet, Inc. www.FormsWorkFlow.com 5(  3DJH  RI  SECTION II — BROKER-OFFICER INFORMATION (CONTINUED) 7. DO YOU RESIDE IN THE STATE OF CALIFORNIA? † NO † YES IF NO, THEN A CONSENT TO SERVICE OF PROCESS (RE 234) MUST ALSO BE COMPLETED. (Refer to #8 instruction on page 4.) 8. BUSINESS TELEPHONE NUMBER (DO NOT LIST FAX NUMBERS.) - REQUIRED ( 9. RESIDENCE TELEPHONE NUMBER - REQUIRED ) ( 10. CELL PHONE NUMBER - REQUIRED ( ) 11. EMAIL ADDRESS ) 12. HAVE YOU EVER USED ANY OTHER NAMES (i.e., MAIDEN NAME, AKA, ETC.)? † NO † YES IF YES, LIST NAMES USED. 13. HEIGHT 14. WEIGHT 15. COLOR OF EYES 16. COLOR OF HAIR 17. GENDER † MALE † FEMALE BACKGROUND INFORMATION Carefully read and provide detailed answers to questions 18-24. You must provide a "yes" or "no" response to all questions, and also completely and accurately provide the detailed information required in item(s) 25 and 26 below. Attach additional sheets if you need more space. Failure to disclose pertinent information may result in denial of your license application and/or delays. 18. HAVE YOU EVER BEEN CONVICTED OF ANY VIOLATION OF THE LAW? ALL STATE AND FEDERAL MISDEMEANOR AND FELONY CONVICTIONS, AND ALL MILITARY AND FOREIGN CONVICTIONS, MUST BE DISCLOSED. CONVICTIONS EXPUNGED UNDER PENAL CODE SECTION 1203.4 OR A SIMILAR STATUTE MUST STILL BE DISCLOSED. IF YES, COMPLETE ITEM 25................................................. † YES † NO 19. ARE THERE CRIMINAL CHARGES PENDING AGAINST YOU AT THIS TIME? IF YES, COMPLETE ITEM 25....................................................... † YES † NO 20. 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 26..................................................................................... † YES † NO 21. ARE THERE ANY LICENSE DISCIPLINARY ACTIONS PENDING AGAINST A BUSINESS OR PROFESSIONAL LICENSE YOU HOLD AT THIS TIME? IF YES, COMPLETE ITEM 26. ......................................................................................................................................................................... † YES † NO 22. 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 25........... † YES † NO 23. 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 ITEM 27........................................................... † YES † NO 24. HAVE YOU EVER PLED GUILTY TO OR ENTERED A PLEA OF NOLO CONTENDERE OR A NO CONTEST PLEA TO ANY VIOLATION OF LAW IN A STATE, MILITARY, OR FEDERAL COURT? IF YES, COMPLETE ITEM 25............................................................................................... † YES † NO CONVICTION DETAILS "Convicted” as used in Item  includes a verdict of guilty by judge or jury, a plea of guilty, a plea of nolo contendere (i.e., "no contest"), or a forfeiture of bail in the courts (including military courts) of any state, commonwealth, possession or country. All convictions must be disclosed, no matter how long ago they occurred, even if the plea or verdict was set aside, the conviction dismissed or expunged, or you have been pardoned. Convictions occurring while you were a minor (under 18 years of age) must be disclosed unless the record of the conviction has been sealed under Section 1203.45 of the California Penal Code or Section 781 of the California Welfare and Institutions Code. 25. DETAILED EXPLANATION OF ITEM    AND/OR  . 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: 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., U.S. CODE, PENAL CODE, ETC.) ***DISPOSITION (i.e., PROBATION, PAROLE, FINE, LENGTH OF TERM, COURT OF CONVICTION ARRESTING AGENCY (Name and Address) (Name and Address) Example: Sacramento Cnty. 456 Main St., Sac Sacramento City Police 123 Main St., Sac DATE OF CONVICTION 2/20/87 TYPE OF CONVICTION … Felony : Misdemeanor * CODE SECTION VIOLATED ** CODE VIOLATED 484 Penal Code *** DISPOSITION CASE NUMBER 6 months probation DQG  ¿QH 1234 … Felony 25A. … Misdemeanor … Felony 25B. … Misdemeanor … Felony 25C. … Misdemeanor 26. DETAILED EXPLANATION OF ITEM 20  AND/OR 2. IF NEEDED, EXPLANATION MAY BE PROVIDED BELOW. 26A. TYPE OF LICENSE 26B. LICENSE ID NO. 26C. LICENSE EXPIRATION DATE 26D. STATE 26E. ACTION (revoked, etc.) 26F. DATE OF ACTION 26G. DATE ACTION TERMINATED 26H. CODE SECTION VIOLATED 27. ADDITIONAL INFORMATION: SPECIFY WHICH LINES YOU ARE REFERRING TO. 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