Free 47415.PDF - Indiana

INDIANA REAL ESTATE COMMISSION
Appointment of Real Estate Commission of State of Indiana
AS

Agent of Broker or Salesman to Accept Service of Process or Pleading

BE IT KNOWN BY THESE PRESENTS THAT I, _______________________________________ of the City of ___________________________________, State of _________________________ do hereby appoint the Real Estate Commission of the State of Indiana as my agent in said State of Indiana upon whom process or pleadings may be served for and on my behalf as a real estate broker or real estate salesman within the meaning of Chapter 44, Acts of 1949 of said State of Indiana. Such appointment shall be deemed to be and is irrevocable. Witness my hand and seal this ______ day of ___________________________, ________.

STATE OF _____________________________ COUNTY OF ___________________________

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SS.

On this ___________ day of ______________________________________ A.D., ___________, personally appeared before me, a notary public in and for said County and State, ______________________________________________________________________ to me known to be the person described in and who executed the foregoing instrument and acknowledged that _________ executed the same as ____________ free act and deed.

Notary Public

My commission expires _________________________, _______

State Form 47415 (R / 7-99)