California Form Re 204 – Fill Out and Use This PDF

This form is to be used by brokers only (including those work-

ing as broker-salespersons). Licensed salespersons must use

RE 214; corporations and corporation oficers must use RE

204A.

Read instructions on reverse side before completing.

Note: License changes with an asterisk may be completed online by using eLicensing. (Refer to information on page 2.)

Type of Change

(Mark one or more boxes)

Mailing address*

Main Ofice Address*

personal name

add/Cancel fictitious Business name

1.liCense iDenTifiCaTion nuMBeR

2.BRokeR naMe (lasT)

BRE UsE Only

(fiRsT)

(MiDDle)

3. BRokeR new peRsonal naMe (lasT)

(fiRsT)

(MiDDle)

CiTy

sTaTe

Zip CoDe

CiTy

BRE UsE Only

sTaTe

Ca

Zip CoDe

pRoC. #

bre use only

CoMMenTs

Try elicensing

Use eLicensing for expedited processing of your change. LicenseescanperformthefollowingtransactionsusingtheeLicensing system at www.bre.ca.gov:

•Broker and salesperson renewals

•License certiicate requests (broker, salesperson, oficer and branch)

•Salesperson additions/changes of employing broker

•Broker discontinuation of salesperson employment

•Mailing address changes

•Broker main ofice address addition/changes

•Automated fee payment and processing

General Information

Type or print clearly in ink (black or blue; do not use red).

Business and license mailing addresses are public information and as such are posted on the Internet and available from BRE via telephone and written requests. Please consider this when identifying a license mailing address.

If you electronically re-create this form to facilitate completion on a computer, the form should not be altered in any manner. To do so, could result in disciplinary action. Also, please make certain you do not delete any preprinted information and are using the latest version of the form.

Broker-salesperson

Many real estate brokers elect to work for other brokers in a capacity similar

to the relationship existing between a licensed real estate salesperson and an employing broker.

However, such broker-salespersons are still licensed by the Bureau of Real Estate (BRE) as real estate brokers. Only by written agreement with another broker are they acting as broker-salespersons. Section 2726 of the Commissioner’s Regulations requires that “… every real estate broker shall have a written agreement with each of his salesmen, whether licensed as a salesman or as a broker under a broker-salesman arrangement.”

Even though a broker may act as a broker-salesperson in a relationship with another broker, for Bureau of Real Estate licensing and record-keeping purposes the licensee is still a broker. This means that a broker-salesperson should still communicate with BRE using only appropriate broker forms and applications.

When using the proper broker forms no reference should be made to the name (or ictitious name) of the broker for whom the broker-salesperson

works. That type of information is irrelevant as there is no reference in the BRE records that such a working relationship exists. It is also imperative that a broker-salesperson speak for himself or herself, meaning that any requests for record changes be made by the broker-salesperson and not by anyone else on his or her behalf.

A broker-salesperson should never use salesperson forms or applications when renewing or making changes to a broker record. Doing so will cause delays in processing whatever is requested. Remember — a broker is

always a broker regardless of any working relationship that may exist with another broker.

Instructions

Check the appropriate “change” box(es) on page 1 and complete all information requested on the application.

Change of Personal Name — Enter full new name (do not refer to any other broker, DBA or company name). Attach veriication of name change (i.e., legible copy of drivers license, marriage certiicate, court order, etc.).

Sign line #12 with your new name. If you have a DBAon record, a Fictitious

Business Name Statement must be reiled with your new name.

Mailing Address — The mailing address (post ofice box, residence or

business address) is used to mail correspondence to you. Non-California Residents — If residing outside the State of California, a

notarized Consent To Service Of Process (RE 234) is also required, if not already on ile. If not maintaining an ofice in California, submit an Out-

of-State Broker Acknowledgment (RE 235).

Main Ofice Address — Enter the new primary business location. The main ofice address mustbe a California address. If a street address is unavailable,

indicate the physical location (i.e., the nearest intersection and the distance to it). If you are no longer working in real estate for which a California license is required, enter “no business address” on line #6. No license will be issued unless requested.

Fictitious Business Name — Do not list your broker’s DBA, if you are working as a broker-salesperson.

To add a DBA to your broker license, enter the name exactly as it appears on the Fictitious Business Name Statement (FBNS) as iled with the County Clerk. The DBA must be iled in the county of your main ofice address. Submit a copy of the FBNS with the “iled stamp” from the County Clerk’s ofice.

•Prior to iling your ictitious business name statement with the county, you may wish to contact a local BRE district ofice, or check our Web site (www.bre.ca.gov) to determine if the name is already in use by another broker.

•The broker licensee’s name must appear as a registrant on the

FBNS. Refer to Section 2731 of the Commissioner’s Regulations for restrictions.

•Proof of Publication is not acceptable, unless it bears the County Clerk’s “iled stamp.”

•Photocopies are acceptable, if they are clear and legible.

To cancel a DBA, complete the entire application. Check the cancel box on line #11A and list the DBA you wish to cancel.

Mailing Information

This application may be submitted in person at any district ofice or mailed to the Sacramento ofice.

Mail To: Bureau of Real Estate

P.O. Box 137004

Sacramento, CA 95813-7004

PRIVACY INFORMATION:

Section 1798.17 of the Civil Code requires this notice be provided when collecting personal or conidential information from individuals. Each

individual has the right to review personal information maintained by this Agency, unless access is exempted by law.

Bureau of Real Estate	Managing Deputy Comm. IV
1651 Exposition Blvd.	Licensing, Examinations, & Education
Sacramento, CA 95815	Telephone: 877-373-4542

General powers of the Commissioner, Sections 10050, 10071, and 10075 of the Business and Professions Code authorizes the maintenance of this information.

Business and Professions Code Sections 30, 31(e) and 494.5(d) require each real estate licensee to initially provide to the Bureau of Real Estate his or her social security number which will be furnished to the Franchise Tax Board. The Franchise Tax Board will use your number

to establish identiication exclusively for tax purposes. These code

sections also require that each application for a new license or renewal provides notiication on the application, that the Board of Equaliza-

tion and the Franchise Tax Board will share taxpayer information with the Bureau of Real Estate, and that failure to pay tax obligations may result in a suspension or denial of a license. The Board of Equalization

and Franchise Tax Board require the Bureau to collect social security numbers and federal taxpayer identiication numbers for the purposes

of matching the names of the 500 largest tax delinquencies pursuant to

Section 7063 or 19195 of the Revenue and Taxation Code. Your social security numbers and federal taxpayer identiication number shall not be

deemed public records and shall not be open to the public for inspection.

The Real Estate Law and the Regulations of the Commissioner require applicants to provide the Bureau with speciic information. If all or

any part of the required information is not provided, processing may

be delayed. In addition, the Commissioner may suspend or revoke a license, or in the case of a license applicant, may deny the issuance for misstatements of facts (including a failure to disclose a material fact) in an application for a license.

The information requested in this form is primarily used to furnish license status information to the Bureau’s Enforcement Section, and to answer inquiries and give information to the public on license status, mailing and business addresses and actions taken to deny, revoke, restrict or suspend licenses for cause.

This information may be transferred to real estate licensing agencies in other states, law enforcement agencies (City Police, Sheriff’s Depart- ments, District Attorneys, Attorney General, F.B.I.), and any other regulatory agencies (i.e., Department of Corporations, Department of In- surance, Department of Consumer Affairs, California Bar Association).