Re 204A Form – Fill Out and Use This PDF

	STATE OF CALIFORNIA		ONly
	DEPARTMENT OF REAL ESTATE
	CORPORATION CHANGE APPLICATION		Use
			DRe
	RE 204A (Rev. 7/18)				DRE RECEIVED DATE
	 Readinstructionsonpage3before	CORpORatiON ChaNges [check appropriate box(es)]
	completing this application.	 MAILING ADDRESS			TELEPHONE/EMAIL ADDRESS
		 MAIN OFFICE ADDRESS			CORPORATION NAME
	 Type or print clearly in black or
		ACTIVATION			DESIGNATED OFFICER
	blue ink.	ADD/CANCEL FICTITIOUS BUSINESS NAME

Indicate the type of change(s) by BROKeR-OFFiCeR ChaNges

marking one or more boxes in the	 OFFICER’S PERSONAL NAME
adjacent column.	 ACTIVATION OF OFFICER
		CORPORATION INFORMATION

DRe Use ONly

1. DRE CORPORATION LICENSE NUMBER

2.FEDERAL TAXPAYER ID NUMBER (RequiRed-See PRivacy notice)

DRE USE ONLY - eff. date of change

8A. NAME OF CURRENT DESIGNATED OFFICER

CORPORATE OFFICER TITLE, IF REMAINING WITH CORP.

8D. NAME OF New DESIGNATED OFFICER

8E. LICENSE ID NUMBER

8F. CORPORATE OFFICER TITLE

8G@. SIGNATURE OF New DESIGNATED OFFICER

DATE

9. OFFICER’S NAME — PRINT AS SHOWN ON LICENSE CERTIFICATE

DRE USE ONLY

@18. SIGNATURE OF OFFICER APPLICANT (MUST BE AN ORIGINAL SIGNATURE)

DATE

general information

Read the following information before completing this application.

If the new designated officer does not currently have an officer license for this corporation, a Corporation License Application

(RE 201) must be submitted in addition to this form.

CorporationBackgroundStatement(RE212)– Commissioner's Regulation 2746 requires the designated officer who obtains the original corporation license to file an RE 212 for any director, chief executive officer, president, first level vice presidents, secretary, chief financial officer and subordinate officers with responsibility

for forming policy of the corporation and all natural persons owning or controlling more than ten percent of its shares, if such

a person has been subject of any of the items enumerated in the regulation. If none of the officers have been a subject of any of the

items enumerated in the regulation, then an RE 212 is not needed. in all instances, the broker-officer must complete and sign the certification on page 2 of this application.

Business and mailing addresses arepublicinformationandassuch are posted on the Internet and available from DRE 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.

type of Change

Check the appropriate box(es) on page 1 and complete all requested

information.

Change of Corporation Name — Enter the new name exactly as it

appearsontheamendedArticlesofIncorporation.Acopyoftheamended

Articles of Incorporation showing the endorsement of the Secretary of State must also be included.

Mailing Address — The mailing address (post office box, residence

or business address) is used to mail correspondence directly to the corporation.

Non-CaliforniaResidents— If residing outside the State of California, a Consent To Service Of Process (RE 234) is also required. If not maintaining an office in California, submit an Out-of-State Broker Acknowledgment (RE 235).

Main Office Address — Enter the new primary business location. The main office address must be located in California. If a street address is

unavailable, indicate the physical location (i.e., the nearest intersection and the distance to it). If the corporation is no longer working in real estate for which a California license is required, enter "no business address" on line #6 and the Department will proceed to cancel the corporation.

Fictitious Business Name — To add a DBA, enter the name exactly as it appears on the Fictitious Business Name Statement (FBNS) as filed with the County Clerk. The corporation name must be listed as the registrant. The FBNS must be filed in the county where your main office is located. Submit a copy of the FBNS with the “filed stamp” from the County Clerk’s office.

•Prior to filing your fictitious business name statement with the county, you may wish to check our Web site (www.dre.ca.gov) to determine if the name is already in use by another broker.

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

•Legible photocopies are acceptable.

•This form may be used to add or cancel one or more DBA’s.

•FBNS must be refiled if the corporation name is being changed. To cancel a DBA, enter the name and check the cancel box.

Change of Officer’s Personal Name — Enter full new name (do not refer to any DBA or company name). Any name change affects all licenses held. Attach verification of name change (i.e., legible copy of drivers license, marriage certificate, court order, etc.). Sign this form with your new name.

Transfer “Designated Officer” Title to Another Licensed Officer Complete Items #8A-8G. The current (resigning) designated officer must sign this form as the resigning designated officer or one of the following documents must be attached:

•a personally signed resignation letter,

•a copy of the Resolution of the Board with the corporate seal,

•a signed statement giving the date of death of the designated officer.

If the new designated officer does not currently have an officer license for this corporation, a Corporation License Application (RE 201) must

be submitted in addition to this form.

License Certificates

A license certificate is available online and can be printed using eLicensing:

•Change of designated officer or requests for corporation or officer name change.

•Adding/deleting fictitious business names.

Mailing information

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

Mail To: Department 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 confidential information from individuals. Each individual has the right to review personal information maintained by this Agency, unless access is exempted by law.

Department of Real Estate	Assistant Commissioner
1651 Exposition Blvd.	Licensing & Administration
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 Department 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 identification exclusively for tax purposes. These code

sections also require that each application for a new license or renewal provides notification on the application, that the Board of Equalization and the Franchise Tax Board will share taxpayer information with the Department 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 Department to collect social security numbers and federal taxpayer identification 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 identification 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 Department with specific 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 Department’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 Departments, District Attorneys, Attorney General, F.B.I.), and any other regulatory agencies (i.e., Department of Business Oversight, Department of Insurance, Department of Consumer Affairs, California

Bar Association).