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DSD 17-1-09 DUAL STATUS DISCLOSURE Page 1 of 1 The printed portions of this form, except differentiated additions, have been approved by the Colorado Real Estate Commission. (DSD 17-1-09) (Mandatory 3-09) THIS DISCLOSURE IS MADE PURSUANT TO THE REQUIREMENTS OF THE COLORADO REAL ESTATE COMMISSION AND THE DIRECTOR OF THE COLORADO DIVISION OF REAL ESTATE. DUAL STATUS DISCLOSURE (REAL ESTATE BROKER AND MORTGAGE BROKER) The Broker, , is a licensed real estate broker and a licensed American LegalNet, Inc. www.FormsWorkFlow.com