Division of Consumer Affairs State Real Estate Appraiser Board 124 Halsey Street 3rd Floor PO Box 45032 Newark New Jersey 07101 973 5046480 5i 1iYZi 6MJi sM li sYri iriYepDivision of Consumer Affair ID: 898042
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1 New Jersey Of ce of the Attorney Gen
New Jersey Of ce of the Attorney General Division of Consumer Affairs State Real Estate Appraiser Board 124 Halsey Street, 3rd Floor, P.O. Box 45032 Newark, New Jersey 07101 (973) 504-6480 5i^ 1iYZi` 6MÄJi sM [li ([[sYri` .iriYep Division of Consumer Affairs State Real Estate Appraiser Board 124 Halsey Street, 3rd Floor, P.O. Box 45032 Newark, New Jersey 07101 (973) 504-6480 Application for Temporary Practice as a Real Estate Appraiser Date: _________________________________________ A nonrefundabletemporary
2 visitingregistrationfeeof$150,intheformo
visitingregistrationfeeof$150,intheformofacheckormoneyordermadeouttotheStateofNew ZKicK of tKese aGGresses Zill Ee consiGereG as \our ´aGGress of recorGµ ,f \ou Go not inGicate E\ puttinJ a cKecN in tKe appropriate Eo[ ZKicK aGGress sKoulG Ee useG as \our aGGress of recorG \our PailinJ aGGress Zill Ee consiGereG to Ee \our aGGress of recorG A post ofÀce ( _______________________ ) Ms. initial 2.Address Home: _________________________________________________________________
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_____________________________ 6treet or 32 %o[=,3 coGe _____________________________________ ___________________________________ ____________________________________________________________________________________________ 6treet or 32 %o[=,3 coGe clear, stylephotograph(2 [ )ofyour headandshoulders,takenwithin photo 20.Name _____________________________________________________________________________________ ___________________________________________________________________
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iption ____________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 21.Assignment ____________________________ Assignment __________________________ *Note: } ss. AFFIDAVIT 7Kis afÀGaYit is to Ee e[ecuteG
7 E\ tKe applicant Eefore a notar\ puElic
E\ tKe applicant Eefore a notar\ puElic State ______________________________________ ____________________________________ I, ___________________________________________ in PaNinJ tKis application to tKe 6tate 5eal (state Appraiser %oarG for tePporar\ licensure or certiÀcation as a real estate appraiser unGer tKe proYisions of 7itle of tKe *eneral 6tatutes of 1eZ -erse\ anG tKe 5ules of tKe 6tate 5eal (state Appraiser %oarG sZear or afÀrP tKat , aP tKe applicant
8 anG tKat all informationprovidedinconne
anG tKat all informationprovidedinconnectionwiththisapplicationistruetothebestofmyknowledgeandbelief.Iunderstandthat an\ oPissions inaccuracies or failure to PaNe full Gisclosures Pa\ Ee GeePeG sufÀcient to Gen\ tePporar\ licensure or , furtKer sZear or afÀrP tKat , KaYe reaG N.J.S.A .45:14F-1 etseq toJetKer ZitK tKe 5ules anG 5eJulations of tKe 6tate 5eal (state Appraiser %oarG .13:40A-1.1 etseq .,andfullyunderstandthatinreceivingtemporarylicensureor investigation purpos
9 e of Yerif\inJ P\ TualiÀcations for teP
e of Yerif\inJ P\ TualiÀcations for tePporar\ licensure or certiÀcation , furtKer autKori]e all institutions ePplo\ers aJencies anG all JoYernPental aJencies anG instruPentalities local state feGeral or foreiJn to release an\ inforPation Àles or ___________________________________________ Signature Sworn _____________ day _________________________ , ____________ Year _____________________________________________ _____________________________________