Real Estate Salesperson Application
2 Certification of Satisfactory Completion
(Name of School)
Real Estate Salesperson Course (Code) # SThis certifies that
has satisfactorily completed a 75-hour salesperson qualifying
(Name of Student)
course in real estate approved by the Secretary of State in accordance with the provisions of Chapter 868 of the Laws of 1977;
that attendance of the student was in compliance with the law and that a passing grade was achieved on the final examination.
The course was completed on
.
Authorized Signature
X
Date
(School Seal)
3 Child Support Statement — You must complete this section.
If you do not complete it, your application will be returned.
“X” A or B, below
I, the undersigned, do hereby certify that (You must “X” A or B, below):
A. [ ] I am not under obligation to pay child support. (SKIP “B” and go directly to Applicant Affirmation).
B. [ ] I am under obligation to pay child support (You must “X” any of the four statements below that are true and apply to you):
[ ]
I do not owe four or more months of child support payments.
[ ]
I am making child support payments by income execution or court approved payment plan or by a plan agreed to by the
[ ]
My child support obligation is the subject of a pending court proceeding.
[ ]
I receive public assistance or supplemental social security income.
parties.
4 Applicant Affirmation — I affirm, under the penalties of perjury, that the statements made in this application are true and correct.
I further affirm that I have read and understand the provisions of Article 12-A of the Real Property Law and the rules and regulations
promulgated thereunder.
Applicant Print Name
X
Date
Applicant’s Signature
DOS-0022 (Rev. 6/08)
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