STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE Serving Californians Since 1917 SALESPERSON CHANGE APPLICATION RE 214 (Rev. ) DRE RECEIVED DATE 9 This form is to be used by salespersons only. Broker salespersons must use RE 204. TYPE OF CHANGE [Check appropriate box(es)] SPONSORING BROKER/CORP.* 9 Read instructions on reverse side before completing. EMPLOYMENT DISCONTINUED PERSONAL NAME MAILING ADDRESS* 9 Note: License changes with an asterisk may be completed on-line by utilizing eLicensing. (Refer to information on page 2.) 1. LICENSE IDENTIFICATION NUMBER DRE USE ONLY ACTIVATION* SALESPERSON INFORMATION 2. SALESPERSON’S NAME — AS IT APPEARS ON LICENSE. — LAST, FIRST, MIDDLE 3. SALESPERSON’S NEW NAME (IF CHANGING) — LAST, FIRST, MIDDLE (See instructions on reverse side; sign line #9 with new name.) 4. SALESPERSON’S MAILING ADDRESS — STREET ADDRESS/P.O. BOX, CITY, STATE, ZIP CODE 5. DO YOU RESIDE IN CALIFORNIA? YES NO 6. SALES. LICENSE EXPIRATION DATE MONTH DAY YEAR IF NO, AN “RE 234” MUST BE ON FILE WITH THIS DEPARTMENT. SEE REVERSE SIDE. 7. BUSINESS TELEPHONE NUMBER (INCLUDE AREA CODE) 8. RESIDENCE TELEPHONE NUMBER (INCLUDE AREA CODE) 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. 9. ¾ SIGNATURE OF SALESPERSON — MUST BE ORIGINAL SIGNATURE, NOT PHOTOCOPY, ETC. DATE NEW SPONSORING BROKER/CORPORATION INFORMATION 10. BROKER/CORPORATION ID NO. DRE USE ONLY 11. SALESPERSON EMPLOYMENT DATE DRE USE ONLY 12. BROKER/CORPORATION NAME — AS IT APPEARS ON LICENSE; NO DBA’S 13. 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. 14. SIGNATURE OF NEW BROKER/LICENSED OFFICER — MUST BE ORIGINAL SIGNATURE, NOT PHOTOCOPY, ETC. DATE 15. PRINTED NAME OF #14 SIGNER 17. BUSINESS TELEPHONE NUMBER ¾ 16. BROKER/CORP. EXPIRATION DATE FORMER BROKER/CORPORATION INFORMATION 18. BROKER/CORPORATION ID NO. 19. DATE SALESPERSON EMPLOYMENT DISCONTINUED 20. BROKER/CORPORATION NAME — AS IT APPEARS ON LICENSE; NO DBA’S 21. SIGNATURE OF FORMER BROKER/LICENSED OFFICER DATE ¾ FOR DRE USE ONLY PROC. # DATE PROCESSED SENDER’S # DATE SENT FORM LETTER/COMMENTS DOCUMENT DATE USED & TYPE (circle one) RD AD American LegalNet, Inc. www.FormsWorkFlow.com KD RE 214 — Reverse Try eLicensing 9 Use eLicensing for expedited processing of your change. It's easy, paperless and interactive. Renewal information is posted immediately on DRE's public information. Licensees can perform the following transactions using the eLicensing system at www.dre.ca.gov: • Broker and salesperson renewals • Duplicate license requests (broker, salesperson, officer and branch) • Salesperson additions/changes of employing broker • Broker discontinuation of salesperson employment • Mailing address changes • Broker main office address addition/changes • Automated fee payment and processing General Information 9 Type or print clearly in ink (black or blue; do not use red). 9 Receipt of this form will not be acknowledged. 9 Business and license mailing addresses are public information and as such are posted on the Internet and available from DRE via telephone and written requests. Please consider this when identifying a license mailing address. 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 Type of Change Check the appropriate box(es) on page 1 and complete the item numbers listed below. Mailing address ................................... Personal name...................................... Activation ............................................ Sponsoring broker ............................... Employment discontinued by broker... Employment discontinued by sales. .... #1–9 #1–9 #1–17 #1–17 (required) & 18–21 (optional) #1, 2, and 19-21 #1, 2, 4-9, &18-20 Change of Personal Name – Enter full new name. Attach verification of name change (i.e., legible copy of drivers license, marriage certificate, court order, etc.). Sign this form with your new name. A new license will be issued bearing the new name. Duplicate License – This form cannot be used to order a duplicate license. Use a Request for Duplicate License (RE 225). Mailing Address – The mailing address (post office box, residence or business address) is used to mail correspondence to you. If your mailing address is that of your broker, please note “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, if not already on file. License Certificates A license certificate is automatically generated for the following transactions: • Requests for personal name change; • Issuance of an unconditional salesperson license following submission of educational requirements of Section 10153.4 of the Business & Professions Code. Mailing Information This application may be submitted in person at any district office or mailed to the Sacramento office. Mail To: Department of Real Estate P.O. Box 187003 Sacramento, CA 95818-7003 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, enter the appropriate ID# and name. • If the salesperson will be working for you under your individual license, enter the name and ID# from that license. • If the salesperson will be working for you under your corporation officer’s license, enter the corporation name and ID# from that license. • Do not list DBA’s on this application. PRIVACY INFORMATION: Section 1798.17 of the Civil Code requires this notice be provided when collecting personal or confidential information from individuals. Each individual has the right to review personal information maintained by this Agency, unless access is exempted by law. Department of Real Estate Managing Deputy Comm. IV 2201 Broadway Licensing, Exam., & Education Sacramento, CA 95818 Telephone:  General powers of the Commissioner, Sections 10050, 10071, and 10075 of the Business and Professions Code authorizes the maintenance of this information. Business and Professions Code Section 30, Chapter 1361, Section 1, requires each real estate licensee to initially provide to the Department of Real Estate his or her social security number which will be furnished to the Franchise Tax Board. Your social security number shall not be deemed a public record and shall not be open to the public for inspection. The Franchise Tax Board will use your number to establish identification exclusively for tax purposes. The Real Estate Law and the Regulations of the Commissioner require applicants to provide the Department with specific information. If all or any part of the required information is not provided, processing may be delayed. In addition, the Commissioner may suspend or revoke a license, or in the case of a license applicant, may deny the issuance for misstatements of facts (including a failure to disclose a material fact) in an application for a license. The information requested in this form is primarily used to furnish license status information to the Department’s Enforcement Section, and to answer inquiries and give information to the public on license status, mailing and business addresses and actions taken to deny, revoke, restrict or suspend licenses for cause. This information may be transferred to real estate licensing agencies in other states, law enforcement agencies (City Police, Sheriff’s Departments, District Attorneys, Attorney General, F.B.I.), and any other regulatory agencies (i.e., Department of Corporations, Department of Insurance, Department of Consumer Affairs, California Bar Association). American LegalNet, Inc. www.FormsWorkFlow.com