WYOMING REAL ESTATE COMMISSION 2617 E. LINCOLNWAY, SUITE H CHEYENNE WYOMING 82002 (307) 777-7141

02/13

RESPONSIBLE BROKER ACTIVE STATUS REQUEST (Activating a NEW responsible broker AND existing company) ATTACH: $60 (Section A and B); $ 30 per license Proof of errors and omissions insurance ($100,000/$500,000) (WWW.WUGIEO.COM) Consent to Examine and Audit form Proof of forty-five (45) hours of continuing education, if applicable

Proof of Wyoming Broker Management

Signed Minutes reflecting appointment of new responsible broker and resignation of former responsible broker. Minutes to also reflect names of current officers/directors, members/managers or partners. Proof from WY Secretary of State that corporation/LLC is in good standing Non-Resident Only: License history from resident state

A.

TO BE COMPLETED BY NEW RESPONSIBLE BROKER REQUESTING ACTIVE STATUS:

RESPONSIBLE BROKER NAME:

(please type or print)

HAVE YOU EVER BEEN CONVICTED OR PLEADED nolo contendere TO A FELONY OR ARE ANY SUCH CHARGES PENDING AT THIS TIME? YES

NO

IF YES, ATTACH EXPLANATION.

HOME MAILING ADDRESS: HOME TELEPHONE NUMBER: DATE:

B.

EMAIL ADDRESS*** SIGNATURE:

ACTIVATING A CURRENT CORPORATION, LLC OR PARTNERSHIP (Complete Sections A and B)

COMPANY NAME TRADE NAME (DBA) BUSINESS ADDRESS BUSINESS MAILING ADDRESS FIRM WEBSITE: BUSINESS TELEPHONE

FIRM EMAIL:*** _ FAX

MY OFFICE COMPLIES WITH LOCAL ZONING REGULATIONS YES NO If you are establishing an office in your home, a letter from your local zoning office is required showing approval. Pursuant to W.S. 33-28-122, provide the name of the Wyoming financial institution and the name of the trust account. If using a funds holder (Wyoming title company/closing agent), include the name and address of the funds holder and provide a signed copy of your agreement with the funds holder. (A sample funds holder agreement is available on the Commission website http://realestate.state.wy.us, under Real Estate Trust Account Guidelines.) _________________________________________________________________________________________________________________________________________ (Attach Voided Trust Account Deposit Slip or signed Funds Holder Agreement)

DATE:

SIGNATURE:

***The WREC primarily communicates through email. Be sure you check your email often and notify the Commission of any changes.

Active Status RB.pdf

Proof from WY Secretary of State that corporation/LLC is in good standing. Non-Resident Only: License history from resident state. A. TO BE COMPLETED BY ...

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