Wisconsin Form 812 PDF Details

Wisconsin Form 812 is a state tax form that must be filed by all Wisconsin residents and businesses. The form is used to report income, exemptions, credits, and other information to the Wisconsin Department of Revenue. Taxpayers are responsible for ensuring that the information on the form is accurate and complete. Filing a false or incomplete Form 812 can result in penalties and fines. For more information, visit the Wisconsin Department of Revenue website.

QuestionAnswer
Form NameWisconsin Form 812
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfm812 form 812 notice of real estate employment

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Wisconsin Department of Safety and Professional Services

Mail To: P.O. Box 8935

1400 E. Washington Avenue

 

Madison, WI 53708-8935

Madison, WI 53703

FAX #:

(608) 261-7083

E-Mail:

dsps@wi.gov

Phone #:

(608) 266-2112

Website:

http://dsps.wi.gov

DIVISION OF PROFESSIONAL CREDENTIALING PROCESSING

NOTICE OF REAL ESTATE EMPLOYMENT

SECTION A: IDENTIFY LICENSEE TO BE EMPLOYED BY OR WORK UNDER THE SUPERVISION OF BROKER. FAILURE TO PROVIDE ALL INFO MAY RESULT IN DELAY OF PROCESSING.

LICENSE # and TYPE:

Broker

Salesperson

Timeshare Salesperson

 

 

 

 

DATE EMPLOYMENT BEGAN:

 

 

 

 

 

 

 

_________________________________________________________________________________________________

Last NameFirst NameMI

________________________________________________________________________________________________

Mailing address (Number, Street,)

________________________________________________________________________________________________

City

State

Zip Code

DATE OF BIRTH:

______ _____ ______

month day year

DAYTIME TELEPHONE NUMBER:

(Include area code)

(______) _______________

LICENSEE MUST SIGN IN THE PRESENCE OF A NOTARY PUBLIC.

I hereby swear and affirm that the answers set forth are true and correct to the best of my knowledge and belief and I understand that failure to comply with the statutes and rules of the Department may be cause for disciplinary action.

______________________________________

_______________

Signature of Licensee

Date

Subscribed and sworn before me this _____________________ day of

________________________________________________, _______.

______________________________________

_______________

Signature of Notary Public

(Seal)

Date Commission

 

 

Expires

APPLICATION FEE: Make check payable to Department of Safety and

Professional Services and attach to this application. Department can process this form only if fee is attached.

For Receipting Use Only

$ 10.00

#812 (Rev. 8/13)

 

Ch. 452, Stats.

Page 1 of 2

Committed to Equal Opportunity in Employment and Licensing

Wisconsin Department of Safety and Professional Services

SECTION B: THIS SECTION IDENTIFIES THE BROKER WITH WHOM OR BY WHOM THE

LICENSEE IN SECTION A WILL BE ASSOCIATED OR EMPLOYED

TYPE OF LICENSE:

Broker-Employer is (check one):

Sole Proprietor Broker

Business Entity (Association, LLC, LLP)

PRINT NAME AND ADDRESS OF BROKER-EMPLOYER EXACTLY AS THAT INDIVIDUAL SOLE PROPRIETOR OR BUSINESS ENTITY IS LICENSED:

_________________________________________________________________________________________________

Business Entity Name

_________________________________________________________________________________________________

Business Address of Broker-Employer’s Main Office (Number, Street, City, State, Zip Code)

_____________________________________________

(_____) ______________________________________

License Number:

Main Office Telephone Number:

This statement must be signed by the sole proprietor broker-employer or a licensed broker who is a director, manager, member, officer, owner or partner of the licensed business entity indicated above.

This is to certify that the broker-employer listed will assume responsibility for the licensee, and failure to comply with the statutes and rules of the Department may be cause for disciplinary action.

_________________________________________________________

Print name of person signing below

 

_________________________________________________________

________________________

Signature of either the sole proprietor broker or a director, manager,

Date

member, officer, owner or partner of the licensed business

 

entity listed above.

 

 

 

#812 (Rev. 8/13)

 

Ch. 452, Stats.

Page 2 of 2

Committed to Equal Opportunity in Employment and Licensing