Real Estate Commission

Address/Name Change Notification

- Please use the form below to report address/names changes, and click submit.

Instructions:

• Section 1 for a change in residence address
• Section 2 for a change in business address
• Section 3 for a name change or to add an alias/nickname
• Individual Brokers: To ensure accurate records, individual brokers must complete both sections #1 and #2 even if the addresses are the same or are not changing.
• Note: If you do not know your license number, go to Online Services and click on Licensee Search. Leave the County Name and Profession Name fields set to ALL. Click on Licensee Name and type your name in the text box provided. Be sure to enter your name specifically as requested (i.e. Doe, John). Click the Search button. When your license record is found, click on Detail to obtain the license number.

1. Change Residence Address:

(IF LICENSED AS AN INDIVIDUAL BROKER, COMPLETE SECTIONS 1 AND 2, EVEN IF THE ADDRESSES ARE THE SAME OR ARE NOT CHANGING.)

First Name: (Required)
Middle Initial:
Last Name: (Required)
License Number:
Street/PO Box (line 1):
Street/PO Box (line 2 if needed):
City:
State:
Zip Code:
Email:
Phone Number with Area Code: (even if not changed)
Cell Number with Area Code: (even if not changed)

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2. Change Business Address

ONLY FOR INDIVIDUAL BROKERS, CORPORATIONS, PARTNERSHIPS, OR ASSOCIATIONS (LLC)
(If licensed as an Individual Broker, complete sections 1 and 2, even if the addresses are the same or are not changing.)

If licensed as an Individual Broker, enter name as it appears on license: (Do Not Use DBA/fictitious name)
First Name:	Middle Initial:	Last Name:

 

If licensed as a Corporation, Association (LLC), Partnership, enter name of company as it appears on license: (Do Not Use DBA/fictitious name)

 

License Number:
Physical Business address: (Number, Street) (PO Box not acceptable)
City:
State:
Zip Code:
Business Phone Number with Area Code: (even if not changed):
Mailing Address of Business if different than above: (i.e. PO Box):
City:
State:
Zip Code:
Email:

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3. Change Individual Name or Add Alias/Nickname:

Previous Name:
First Name:	Middle Initial:	Last Name:
New Name:
First Name:	Middle Initial:	Last Name:

Aliases or Nicknames:
License Number:

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Please type the numbers displayed above in the box below.

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