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.
| Question | Answer |
|---|---|
| Form Name | Wisconsin Form 812 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | fm812 form 812 notice of real estate employment |
Wisconsin Department of Safety and Professional Services
Mail To: P.O. Box 8935 |
1400 E. Washington Avenue |
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Madison, WI |
Madison, WI 53703 |
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FAX #: |
(608) |
dsps@wi.gov |
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Phone #: |
(608) |
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 |
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DATE EMPLOYMENT BEGAN: |
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_________________________________________________________________________________________________
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
________________________________________________, _______.
______________________________________ |
_______________ |
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Signature of Notary Public |
(Seal) |
Date Commission |
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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) |
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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: |
Sole Proprietor Broker
Business Entity (Association, LLC, LLP)
PRINT NAME AND ADDRESS OF
_________________________________________________________________________________________________
Business Entity Name
_________________________________________________________________________________________________
Business Address of
_____________________________________________ |
(_____) ______________________________________ |
License Number: |
Main Office Telephone Number: |
This statement must be signed by the sole proprietor
This is to certify that the
_________________________________________________________
Print name of person signing below |
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_________________________________________________________ |
________________________ |
Signature of either the sole proprietor broker or a director, manager, |
Date |
member, officer, owner or partner of the licensed business |
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entity listed above. |
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#812 (Rev. 8/13) |
|
Ch. 452, Stats. |
Page 2 of 2 |
Committed to Equal Opportunity in Employment and Licensing