Free 45666.PDF - Indiana

APPLICATION FOR APPROVAL OF REAL ESTATE APPRAISER SCHOOL OR COURSE
Sta te Form 4 5666 (R2 / 2-03 ) Ap proved by State Board of A ccoun ts, 200 3

Indiana Professional Licensing Agency Real Estate Appraiser Licensure and Certification Board 302 West Washington Street, Room E034 Indianapolis, Indiana 46204-2700 (317) 232-2980

FEE: $500.00
Da te of a pplication

NAME AND ADDRESS OF SCHOOL OR COURSE PROVIDER
Na me of school or course provider Business teleph one

Addre ss (number and stre et, city, state, ZIP co de)

NAMES AND ADDRESSES OF DIRECTORS AND OFFICERS
Na me Title

Addre ss - re side nce (n umber and stree t, city, state , ZIP cod e)

Name

Title

A ddress - residen ce (nu mbe r a nd street, city, state, ZIP code)

Name

Title

A ddress - residen ce (nu mbe r a nd street, city, state, ZIP code)

Name

Title

Add ress - residence (number and street, ci ty, state, ZIP code)

Attach: a copy of the Certificate of Incorporation; a Certificate of Good Standing of the Corporation issued by the Secretary of State of Indiana. PROOF OF SURETY BOND ACCREDITATION CERTIFICATE Attach: proof of surety bond in the amount of $10,000. Attach: copy of accreditation certificate, if any. LENGTH OF COURSE
Total length of the co urse in classroom h ours Cla ssroo m hour s per calend ar wee k Cla ssroo m hour s per daily se ssion Total amoun t of course weeks

TEACHING SYLLABUS Attach: detailed teaching syllabus.

WRITTEN EXAMINATION
Written exa min atio n r equire d u pon co urse completion ? Yes No

COURSE COMPLETION CERTIFICATE Attach: certificate to be issued to students successfully completing course. TEXT BOOKS
Title of primary textb ook Author Publisher

Title of add ition al textbook

A uth or

P ublisher

Title of ad ditional te xtbook

Author

Pub lish er

Title of additiona l textbo ok

Author

Publisher

OTHER SOURCES OF INSTRUCTION MATERIAL
List sources ( wo rkbo oks, vide o, cassette tape s, e tc.)

Page 1 of 3 pages

Attach: Textbooks, workbooks and instructional materials which will be returned upon review. I (we) the undersigned, submit this application in conformance with IC 25-34.1-8-13, IC 25-34.1-8-14 and the rules of the Indiana Real Estate Commission pertaining thereto for real estate appraiser course approval. I (we) understand that any violation of the license law or rules on my (our) part will subject me (us) to loss of approval. I (we) further certify that to the best of my (our) knowledge, the information given in this application is true and correct. STA OF TE COUNTY OF
Signa ture of principal, office r or dir ector of school or co urse p rovider Si gnature of Notary P ublic

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SS:

Printed name and title of p rincipal, o ffi cer or dire ctor of sch ool or co urse p rovi der

Pr inte d o r typed name of Notary Pu blic Date commissio n e xpir es

Da te subscr ibed and swo rn to Nota ry Pub lic

Coun ty o f residence

SUMMARY OF DOCUMENTS TO BE ATTACHED BEFORE RETURNING THIS COMPLETED APPLICATION 1. 2. 3. 4. 5. 6. 7. Copy of the certificate of incorporation. Certificate of good standing of the corporation issued by the Secretary of State of Indiana. Proof of surety bond in the amount of $10,000. Copy of accreditation certificate, if any. Detailed teaching syllabus. Certificate to be issued to students successfully completing course. Textbooks, workbooks, and instructional materials.

Return to: Indiana Professional Licensing Agency REAL ESTATE APPRAISER LICENSURE AND CERTIFICATION BOARD 302 West Washington Street, Room E034 Indianapolis, Indiana 46204-2700
Ap plicatio n a pproved Date

Ap plicatio n d enied

Date

Ap plicatio n table d

Date

Page 2 of 3 pages

BOND REPORT
State Form 4566 6 (R2 / 2-0 3) App rove d b y State B oard of Accounts, 2003

(STATE OF INDIANA)

SS: BEFORE THE INDIANA REAL ESTATE APPRAISER LICENSURE AND CERTIFICATION BOARD

__________________________________________________ , as Principal, and __________________________________________________ , as Surety, agree to be responsible to the Indiana Real Estate Appraiser Licensure and Certification Board and its' successors in interest as well as an unnamed third party, in the penal sum of $ ___________________ for damages arising out of the Principals failure to comply with all requirements of an approved real estate appraiser course as found in IC 25-34.1-8-13, IC 25-34. 1-8-14 and the rules hereafter promulgated under 25-34.1-3-8. The bond may not be revoked by the Surety except upon ninety (90) days written notice to the Indiana Real Estate Appraiser Licensure and Certification Board by the Surety. The effective day of this bond shall be the date that it is executed by the Surety. IN WITNESS WHEREOF, the Principal and Surety have executed this bond on this __________________________ day of _____________________________ , __________________ .

Page 3 of 3 pages