Free 47330.PDF - Indiana

APPLICATION FOR LICENSE ACTIVATION
State Form 47330 (R2 / 11-02) Approved by State Board of Accounts, 2002

*SOCIAL SECURITY NUMBER
This State agency is requesting disclosure of your Social Security number under IC 4-1-8-1 in order to perform its statutory function. Disclosure is mandatory.

APPLICANT INFORMATION:

In order to reactivate an inactive license during a two (2) year licensure period, the licensee must obtain the six (6) hours of continuing education required by IC 25-34.1-9-11 (1) for that two (2) year licensure period and pay a ten dollar ($10) fee. The ten (10) elective hours must be shown at the end of the renewal period. You may complete the entire sixteen (16) hours. Complete Sections A and B to activate license with a broker. Complete Section A to reactivate without a broker. Submit fee of $10.00. All fees are nonrefundable and nontransferable Attach proof of six (6) core hours, or sixteen (16) hours of continuing education. Indiana Professional Licensing Agency Send to: 302 W. Washington St., Rm. E034 Indianapolis, IN 46204 T elephone: (317) 232-2980

INSTRUCTIONS: 1. 2. 3. 4. 5. 6.

FOR BROKER ACTIVATION
CHECK ONLY IF APPLICABLE

Salesperson Activation
SECTION A
Name of applicant

Broker Activation

Referrals Only

WILL HOLD MY OWN LICENSE

APPLICANT INFORMATION
License number

Residential address (number and street)

T elephone number

(
City, state, ZIP code

)

Date (month, day, year)

*Social Security number

Signature of applicant

SECTION B

SALESPERSON'S OR BROKER'S REQUESTED REASSIGNMENT

The licensed broker for the State of Indiana named below requests the license of the Salesperson/Broker to be reassigned to the requesting broker with full responsibility for Salesperson's/Broker's actions in real estate transactions while in Broker's Association.
Name of requesting broker Date (month, day, year)

Name of company

IB No. only ____________________ or CO No. _______________________
Address (number and street) Requesting broker's residential address (number and street)

City, state, ZIP code

T elephone number

City, state, ZIP code

(
*Requesting broker's Social Security number

)
Signature of requesting broker

OFFICE USE ONLY

AB - Associate Broker (broker working for another broker) IB - Independent Broker (broker NOT working for another broker)

NOTE: Licenses cannot be assigned to an Associate Broker.