Change Application Business Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: Change Application Business, COM 3684, Ohio Statewide, Department Of Commerce
Please visit our website at www.com.ohio.gov/real 614 | 466-4100 Fax 614 | 644-0584 TTY/TDD: 800 | 750-0750 REAL ESTATE CHANGE APPLICATION - BUSINESS This form is interactive. You may, before printing, type your responses directly onto the form. Otherwise, this form must be typewritten or printed legibly in black ink. Incomplete or incorrect applications will be returned for correction. A check or money order for any fees, made payable to Division of Real Estate & Professional Licensing must be remitted with this form. Cash will not be accepted. Do not use this form if you are registering a completely new company with a new registration/charter number from the Ohio Secretary of State. Use the Association, Corporation, LLC, or Partnership Application as appropriate. FEE: $25.00 FOR DIVISION USE ONLY FILE NUMBER Prior to submitting an application to the Ohio Division of Real Estate & Professional Licensing, any brokerage that is changing or establishing a Doing Business As (DBA) name must have the name approved by this Division and the Secretary of State. Please contact the Division first to have your DBA approved. Only after your name has received approval with this Division should you contact the Secretary of State to assure that the name is also available on their system. Once an available name is approved by this Division, submit a letter requesting the approved name be reserved. Include the name and the file number of a licensee along with a check or money order for $10 to hold the name for 60 days. This will allow time for the Secretary of State to process your registration paperwork. Please submit, with this application, a copy of the certificate from the Secretary of State that proves your business entity and name certification are properly registered with that office. If you are only changing your company name and not changing your charter number or your DBA name, please submit your new company name registration along with this application. Be certain to include all required items when submitting this form. REASON FOR COMPLETING THIS FORM (check all that apply) CHANGE BUSINESS ADDRESS (complete sections 1, 2, and 5; no fee) – Return Company/Broker Original License CHANGE OF BUSINESS ENTITY NAME (Complete sections 1, 2, 3, 5 and 6; submit a letter from the bank at which the trust/special account is held that includes the account-holder name, the account number, and a statement that the account is a non-interest bearing trust or special account; if more than one broker or one or more salesperson is involved in this transaction, complete and submit the Multiple License Transfer Affidavit [COM 3683]; remit $25 application fee, $25 fee for each salesperson license and $25 fee for each broker license, not to exceed a total of $6,000.) CHANGE OR ESTABLISH NEW FICTITIOUS OR DOING BUSINESS AS (D.B.A.) NAME (Complete sections 1, 2, 4, 5, and 6; submit a letter from the bank at which the trust/special account is held that includes the account D.B.A. name, the account number, and a statement that the account is a non-interest bearing trust/special account; if more than one broker or one or more salesperson is involved in this transaction, complete and submit the Multiple License Transfer Affidavit [COM 3683]; remit $25 application fee, $25 fee for each salesperson license and $25 fee for each broker license, not to exceed a total of $6,000.) REPLACE LOST OR DAMAGED LICENSE: CHOOSE ONE: ___ REISSUE LICENSE; ___ PLACE LICENSE IN INACTIVE STATUS (Complete sections 1, and 2; complete section 5 if applicable; $25 fee.) 1. APPLICANT FILE NUMBER, COMPANY FILE NUMBER, & FEDERAL TAX ID*** 2. CURRENT BUSINESS ENTITY NAME 3. NEW BUSINESS ENTITY NAME 4. NEW FICTITIOUS OR D.B.A. NAME APPLICANT FILE NUMBER COMPANY FILE NUMBER CURRENT BUSINESS ENTITY NAME NEW BUSINESS ENTITY NAME NEW FICTITIOUS OR D.B.A. NAME STREET ADDRESS 5. NEW BUSINESS ADDRESS FEDERAL TAX ID BUSINESS PHONE ( CITY 6. Name of applicant or broker/officer/member/partner authorized to bind same. (type or print) COUNTY ) STATE ZIP CODE + 4 Signature of applicant or broker/officer/member/partner authorized to Date bind same. ***THIS APPLICATION CANNOT BE PROCESSED WITHOUT THE APPLICANT AND COMPANY FILE NUMBERS INDICATED IN STEP 1 ABOVE. NOTICE: Evidence that payment has been refused by the drawer's bank upon a check drawn to the order of the Ohio division of real estate shall constitute prima facie evidence of misconduct and shall constitute a violation of division (A)(6) of section 4735.18 of the Revised Code. Page 1 of 1 COM 3684 (Rev. 05/2010) “An Equal Opportunity Employer and Service Provider” American LegalNet, Inc. www.FormsWorkFlow.com