Free 00932.PDF - Indiana

FOR OFFICE USE ONLY

APPLICATION FOR REAL ESTATE LICENSE AS A CORPORATION
State Form 932 (R6/4-94) Approved by State Board of Accounts 1991

Pursuant to IC 25-1-8-2(e), all fees are nonrefundable and nontransferable. INSTRUCTIONS: 1. Fo r b ranc h o ffice re gis tration , ple ase requ es t Bra nc h O ffice Regis tratio n Form (s) 2. Attach copy of Certificate of Incorporation from the Secretary of State. 3. If company has been incorporated for more than a year, also enclose a copy of Certificate of Existence. 4. If remittance is by personal check, the license will be held for two (2) weeks. 5. Mail fifty dollar ($50.00) License Fee to: Indiana Real Estate Commission Indiana Professional Licensing Agency 302 W. Washington St., Rm. E034 Indianapolis, IN 46204 CORPORATION INFORMATION
Name of corporation

CN OU NM TB RE OR L

* Your Federal identification number is requested in accordance with IC 4-1-8.1. However disclosure is not mandatory. The number will be given to the Indiana Department of Revenue.

Federal identification number *

County

Address (number and street, city, state, ZIP code)

LICENSE NUMBER

OFFICER'S NAME

TITLE

RESIDENTIAL ADDRESS

LICENSE NUMBER

NAME OF PRINCIPAL BROKER

RESIDENTIAL ADDRESS

LICENSE NUMBER

NAME OF SALESPERSONS AND BROKERS

(CHECK ONLY ONE) Salesperson Broker Salesperson Broker Salesperson Broker Salesperson Broker Salesperson Broker

RESIDENTIAL ADDRESS

Signature of Secretary, President, or Vice President

Date

Telephone number

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