Free AP-218 Application for Arbitrator Registry - Texas

APPLICATION FOR ARBITRATOR REGISTRY - INDIVIDUALS ONLY


SUSAN COMBS · COMPTROLLER OF PUBLIC ACCOUNTS

INFORMATION ON THIS FORM AND ALL ATTACHMENTS ARE SUBJECT TO DISCLOSURE UNDER THE TEXAS PUBLIC
INFORMATION ACT. ALL OR PART OF THIS INFORMATION WILL BE PUBLISHED IN THE REGISTRY OF ARBITRATORS OR
POSTED ON A WEB SITE AVAILABLE TO THE PUBLIC

To be included on the Arbitrator Registry maintained by the Comptroller of Public Accounts, an agency of the State of Texas, a qualified arbitrator (applicant) must submit a completed application form and attachments to the Comptroller certifying that the applicant possesses the requisite credentials and certifications and agrees to perform the arbitration service for no more than $450 per arbitration. To remain on the Registry, a successful applicant must timely update any changes to his or her information. Applications must be completed by an individual; businesses may not apply on behalf of their employees. By submitting an application for inclusion in the Registry, each applicant acknowledges and understands that he or she must conduct each arbitration for which he or she is appointed in the manner required under applicable law, including without limitation, §§ 41A.08 and 41A.09, Texas Tax Code, and administrative rules and procedures adopted by the Comptroller. The applicant further acknowledges and understands that the requirements of Comptroller Rule 9.804 must be met and that the applicant does not violate Registry disqualifications regarding certain employment, public service, and other matters. Violation of the rule will result in the immediate removal of the arbitrator from the Registry. The $450 fee is the statutory maximum; all other expenses and costs must be borne by the arbitrator and the parties to the arbitration. As provided in the law and rule, the Comptroller shall appoint arbitrators, either by agreement of the parties or based on information provided in the application. By submitting an application, the applicant acknowledges and understands that inclusion in the Registry does not guarantee appointment for any minimum number of arbitrations. FOR ASSISTANCE - If you have any questions about this application, contact the Texas State Comptroller's Office toll free at 1-800-252-9121. The local number in Austin is 512/305-9999. The E-mail address is: [email protected] AMERICANS WITH DISABILITIES ACT- In compliance with the Americans with Disabilities Act, this document may be requested in alternative formats by calling toll-free 1-800-252-9121. FEDERAL PRIVACY ACT - Disclosure of your social security number is required and authorized under law, for the purpose of tax administration and identification of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable federal law. PUBLIC INFORMATION ACT - Section 552.147, Tex. Govt. Code excepts social security numbers from disclosure. If this form is requested as public information, your social security number will not be released. You have certain rights under Ch. 559, Tex. Govt. Code, to review, request, and correct information we have on file about you. Contact us at the address or toll-free number listed on this form. CLEAR in shaded areas. · TYPE OR PRINT IN BLACK INK · Do NOT writeALL FIELDS

ARBITRATOR INFO.

1. Taxpayer number for reporting any Texas tax OR Texas identification number if you now have or have ever had one ........................................................................ 2. Social Security Number* (REQUIRED) ........................................................................................................................

* Your Social Security number is not subject to public disclosure according to Section 552.147, Tex. Govt. Code.

3. Individual's First Name, Middle Initial, Last Name, Suffix, (i.e., Jr., III, etc.)
First Name M.I. Last Name Suffix

4. Mailing Address, City, State, Zip Code with extension
Street number, P.O. Box, or rural route and box number

City

State/province

ZIP code

County (or country, if outside the U.S.)

CONTACT INFORMATION

Phone Number

5. Daytime phone number ...................................................................................................................................
6. E-mail address (optional)* ..............

*Your E-mail address is confidential according to Section 552.137, Tex. Govt. Code; however, by including the E-mail address on this form, you are affirmatively consenting to its release under the Public Information Act. Fax Number

7. Fax number (optional) .....................................................................................................................................
8. Physical location (optional)
Street number, or rural route and box number (do NOT use PO Box)

City

State/province

ZIP code

County (or country, if outside the U.S.)

AP-218-1 (Rev.1-07/3)

AP-218-2
(Rev.1-07/3)


Page 2

9. Company name or affiliation (optional)

10.

Applicant certifies that he/she has completed at least 30 hours of training in arbitration and alternative dispute resolution procedures from the following university, college, or legal or real estate trade association and has attached a copy of the certificate to this application:
Month Day Year

11. Applicant certifies that he/she has a current license and/or certification and has attached a copy. If applicant has both a license and a certification, indicate which license or certification is primary. Renewals for the Arbitration Registry will be based on the expiration date of the chosen primary license or certification. A. Licensed as a real estate broker or salesperson
under Chapter 1101, Occupations Code ...............................
Certified as a real estate appraiser
under Chapter 1103, Occupations Code .........
Month License number Month Day Year

Expiration date Day Year

PRIMARY

PROFESSIONAL INFORMATION

B.

TXCertification number Expiration date

PRIMARY

12. Applicant's current areas of appraisal or real estate expertise: Residential ............................................................................................................................................................
Commercial .......................................................................................................................................................... Minerals ................................................................................................................................................................ Agricultural .......................................................................................................................................................... Land ..................................................................................................................................................................... Other (please describe) 13. Applicant is willing to arbitrate (check all that apply): In person, at any location within the region/s or county/ies indicated By teleconference By written documents submitted by the property owner and appraisal district without a meeting Years of experience Years of experience Years of experience Years of experience Years of experience Years of experience

14. From the table on the following pages select the region/s and/or county/ies in which you are willing to conduct arbitration

Applicants must complete the attached resume that includes information regarding educational background, past and present employment and information relevant to the applicant's qualifications under the law and rules. As with all attachments to and information submitted with this application, resumes are public information under the Public Information Act and may be posted on a Web site. Applications may be mailed to:
Texas Comptroller ­ Arbitrator Registry Application
Property Tax Division
Post Office Box 13528
Austin, Texas 78711-3528


In submitting this application, applicant agrees to: (a) conduct binding arbitration proceedings and issue awards according to applicable law, including but not limited to the requirements of §§41A.08 and 41A.09, Texas Tax Code, and administrative rules and procedures adopted by the Comptroller; (b) inform the Comptroller of any change to the information provided on this application in a timely manner; and (c) conduct each arbitration for which applicant is appointed by the Comptroller for a fee not to exceed $450 per hearing, including all expenses. IF APPLICANT MAKES AFALSE STATEMENT ON THIS FORM, IN ANYATTACHMENTS TO THIS FORM OR IN ANY INFORMATION SUBMITTED TO THE COMPTROLLER UNDER APPLICABLE LAW AND RULES, APPLICANT COULD BE FOUND GUILTY OF A CLASS A MISDEMEANOR OR A STATE FELONY UNDER SECTION 37.10, TEXAS PENAL CODE. THE COMPTROLLER MAY REMOVE A PERSON FROM THE REGISTRY OF ARBITRATORS AT ANY TIME DUE TO FAILURE TO MEET STATUTORY QUALIFICATIONS OR TO COMPLY WITH REQUIREMENTS OF LAW OR ADMINISTRATIVE RULE OR FOR GOOD CAUSE AS DETERMINED BY THE COMPTROLLER.
Month Day Date Year

AP-218-3 (Rev.1-07/3)

Page 3

15. Social Security Number* (Same as #2 on Page 1) ......................................................................................................
* Your Social Security number is not subject to public disclosure according to Section 552.147, Tex. Govt. Code.

PLEASE INDICATE BELOW REGIONS AND/OR COUNTIES WHERE YOU WOULD BE
WILLING TO CONDUCT ARBITRATIONS
(Please check boxes)

To be an arbitrator statewide, check the "statewide" box only. Checking additional boxes will invalidate (cancel) the original selection.

STATEWIDE To be an arbitrator for a designated region that covers "all" listed counties, check the "region" box only. Checking additional county boxes within the same designated region or statewide box will invalidate (cancel) the original selection. To be an arbitrator for designated county/counties that does NOT include the entire region, check the designated county box(es) only. An arbitrator may select multiple county boxes throughout various regions. An arbitrator may have the option to oversee an entire region AND individual counties from other regions. For example, an arbitrator may oversee the Capital Region and individual counties from the Central Texas Region. ALAMO REGION
Atascosa Bandera Bexar Comal Frio Gillespie Guadalupe Karnes Kendall Kerr Medina Wilson

CAPITAL REGION
Bastrop Blanco Burnet Caldwell Fayette Hays Lee Llano Travis Williamson

CENTRAL TEXAS REGION
Bell Bosque Brazos Burleson Coryell Falls Freestone Grimes Hamilton Hill Lampasas Leon Limestone Madison McLennan Milam Mills Robertson San Saba Washington

COASTAL BEND REGION
Aransas Bee Brooks Calhoun DeWitt Duval Goliad Gonzales Jackson Jim Wells Kenedy Kleberg Lavaca Live Oak McMullen Nueces Refugio San Patricio Victoria

GULF COAST REGION
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton

HIGH PLAINS REGION
Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum

AP-218-4 (Rev.1-07/3)

Page 4

PLEASE INDICATE BELOW REGIONS AND/OR COUNTIES WHERE YOU WOULD BE
WILLING TO CONDUCT ARBITRATIONS
(Please check boxes)

To be an arbitrator for a designated region that covers "all" listed counties, check the "region" box only. Checking additional county boxes within the same designated region or statewide box will invalidate (cancel) the original selection. To be an arbitrator for designated county/counties that does NOT include the entire region, check the designated county box(es) only. An arbitrator may select multiple county boxes throughout various regions. An arbitrator may have the option to oversee an entire region AND individual counties from other regions. For example, an arbitrator may oversee the Capital Region and individual counties from the Central Texas Region. METROPLEX REGION
Collin Cooke Dallas Denton Ellis Erath Fannin Grayson Hood Hunt Johnson Kaufman Navarro Palo Pinto Parker Rockwall Somervell Tarrant Wise

NORTHWEST TEXAS REGION
Archer Baylor Brown Callahan Clay Coleman Comanche Cottle Eastland Fisher Foard Hardeman Haskell Jack Jones Kent Knox Mitchell Montague Nolan Runnels Scurry Shackelford Stephens Stonewall Taylor Throckmorton Wichita Wilbarger Young

SOUTH TEXAS BORDER REGION
Cameron Dimmit Edwards Hidalgo Jim Hogg Kinney La Salle Maverick Real Starr Uvalde Val Verde Webb Willacy Zapata Zavala

SOUTHEAST TEXAS REGION
Angelina Hardin Houston Jasper Jefferson Nacogdoches Newton Orange Polk Sabine San Augustine San Jacinto Shelby Trinity Tyler

UPPER EAST TEXAS REGION
Anderson Bowie Camp Cass Cherokee Delta Franklin Gregg Harrison Henderson Hopkins Lamar Marion Morris Panola Rains Red River Rusk Smith Titus Upshur Van Zandt Wood

UPPER RIO GRANDE REGION
Brewster Culberson El Paso Hudspeth Jeff Davis Presidio

WEST TEXAS REGION
Andrews Borden Coke Concho Crane Crockett Dawson Ector Gaines Glasscock Howard Irion Kimble Loving Martin Mason McCulloch Menard Midland Pecos Reagan Reeves Schleicher Sterling Sutton Terrell Tom Green Upton Ward Winkler

AP-218-5 (Rev.1-07/3)

Page 5

RESUME INFORMATION FOR ARBITRATOR REGISTRY
·TYPE OR PRINT IN BLACK INK · USE NON-COLORED PAPER ONLY · DO NOT ATTACH ADDITIONAL MATERIALS

FOR COMPTROLLER USE ONLY

ARBITRATOR INFORMATION
Individual's First Name, Middle Initial, Last Name, Suffix, (i.e., Jr., III, etc.)
First Name M.I. Last Name Suffix

EDUCATION
Type of School Undergraduate Colleges or Universities Name and Location of School Date Graduated Type of Diploma or Degree Fields of Study

Graduate Schools

Technical, Vocational or Business Schools

TRAINING In addition to the arbitration training that you were required to complete in order to qualify as an arbitrator for property tax appeals, list professional training that you have completed in property appraisal, real estate sales, or other areas related to property valuation.

PROFESSIONAL ORGANIZATIONS Please list all professional organizations from which you have a license or certificate or to which you belong.

AP-218-6 (Rev.1-07/3)

Page 6

EMPLOYMENT BACKGROUND

FOR COMPTROLLER USE ONLY

Please list your previous employment, starting with your most recent job first. Do not list any experience from more than ten (10) years previous.
Position Title Location Employer Length of Work

Description of Duties

Position Title Location

Employer Length of Work

Description of Duties

Position Title Location

Employer Length of Work

Description of Duties

Position Title Location

Employer Length of Work

Description of Duties

CIVIC AND COMMUNITY ORGANIZATIONS List any organizations to which you currently belong.

OTHER INFORMATION Do you speak a language other than English? If "YES", what language(s) do you speak? YES NO