Form Re 620 004A PDF Details

Form Re 620 004A is a document used to request a review of an IRS determination. This form can be used by individuals or businesses who disagree with an assessment, determination, or collection action made by the IRS. The form must be completed and submitted to the IRS within 30 days of the date of the letter or notice that you are protesting. If you do not submit the form within 30 days, your right to appeal may be waived.

Form NameForm Re 620 004A
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other names620004A washington state real estate license renewal form 620 004

Form Preview Example

Real Estate License Transfer,

Name Change or Reactivation Application

You can use this form to change your name, transfer or reactivate your license. If you are applying for your first broker or managing broker license or reinstating your license, use form RE-620-004, Real Estate License Application. Send this completed form and any required documents to:

Real Estate Licensing

Department of Licensing

PO Box 9021

Olympia, WA 98507

(360) 664-6500 or (360) 664-6488

To transfer your license:

Complete this form and return your current license showing the office you are leaving.

To change your name:

Complete with this form and enclose a brief letter stating what your name is being changed to and from.

Check all that apply:


Name change


Applicant information – Incomplete applications will not be processed.

TYPE or PRINT Name (as it appears on your license, if applicable)

Date of birth

Home address

(Area code) Telephone number



ZIP code


Answer the following

If you answer “Yes” to questions 1-5, attach a letter of explanation. Include the charge, date of conviction, civil judgment or order, county jurisdiction, state, and disposition of charges.

1.With the exception of motor vehicle violations, have you been convicted of a gross misdemeanor or felony, in this or any other state, by the federal government or by any other jurisdiction

within the past ten years?



2.Is there a criminal complaint, accusation, or information presently pending against you or are you currently under indictment, in this or any other state, by the federal government or by any

other jurisdiction?



3.Has any professional or occupational license, certification, or permit held by you been fined, suspended, revoked, refused, or denied, in this or any other state, by the federal government

or by any other jurisdiction in the past ten years?



4.Have you ever had a civil court order, verdict, or judgment entered against you in any court of competent jurisdiction, in this or any other state, by the federal government or by any other

jurisdiction in the past ten years?

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . Yes


5. Are you currently required to register as a sex offender in this state or any other state?

. . . . . . . Yes


If yes, in which state


and county




I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.




Date and place signed


Applicant signature

NOTICE: The Department of Licensing may enter your real estate firm’s licensed office location at reasonable times to inspect the records that you are required to keep by the statutes and rules that govern the license for which you are applying. It is your responsibility as a licensee to cooperate with an audit or an investigation by providing DOL with the requested documents and a written explanation of the matter contained in a complaint upon the Department’s request.

RE-620-004A (R/1/12)WRA Page 1 of 2

Employing irm information

TYPE OR PRINT Firm name (where applicant will be licensed)

Firm license number




Mailing address

(Area code) Telephone number






ZIP code




Physical address (if different)








ZIP code




TYPE OR PRINT Designated broker name as it appears on your license

License number




TYPE OR PRINT Branch manager name as it appears on your license

License number




I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.




Date and place signed


Designated broker/ Branch manager signature*

*Submit a copy of the delegation authority if not signed by the designated broker or branch manager.

Once iled, this application is a public record and is subject to public disclosure.


For ofice use only

License number

Effective date

Expiration date

Firm number





RCW 18.85.191; 18.85.361(6); 26.23.150; 42.56.

RE-620-004A (R/1/12)WRA Page 2 of 2

We are committed to providing equal access to our services. If you need accommodation, please call (360) 664-6500 or TTY (360) 664-0116.

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Step 1: Click on the "Get Form" button above on this page to access our editor.

Step 2: Once you open the online editor, you will notice the document prepared to be completed. Apart from filling out various fields, you may also do various other actions with the Document, that is putting on custom textual content, editing the original text, inserting graphics, putting your signature on the form, and a lot more.

This form will require specific information to be filled in, thus make sure to take your time to fill in exactly what is requested:

1. Begin filling out your Form Re 620 004A with a selection of essential blanks. Gather all of the information you need and be sure there is nothing overlooked!

Step no. 1 of completing Form Re 620 004A

2. Once your current task is complete, take the next step – fill out all of these fields - With the exception of motor, or felony in this or any other, Yes, Is there a criminal complaint, currently under indictment in this, Yes, Has any professional or, Have you ever had a civil court, competent jurisdiction in this or, If yes in which state, and county, Yes, Yes Yes, No No, and I certify under penalty of perjury with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

I certify under penalty of perjury, competent jurisdiction in this or, and Is there a criminal complaint in Form Re 620 004A

3. Completing Employing irm information, TYPE or PRINT Firm name where, Mailing address, City, Physical address if different, City, TYPE or PRINT Designated broker, TYPE or PRINT Branch manager name, Firm license number, Area code Telephone number, State, ZIP code, State, ZIP code, and License number is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Form Re 620 004A writing process clarified (step 3)

Many people frequently get some things wrong while completing City in this area. You should definitely reread what you type in here.

Step 3: Check the details you've typed into the blank fields and then hit the "Done" button. After starting a7-day free trial account at FormsPal, you'll be able to download Form Re 620 004A or send it via email immediately. The PDF form will also be accessible via your personal cabinet with your each change. FormsPal is invested in the privacy of our users; we always make sure that all information processed by our editor continues to be confidential.