Michigan Securities Commission (Department Of Real Estate.)

To the Michigan Securities Commission, Lansing, Michigan:

In compliance with Act No. 306 of the Public Acts of 1919,

I (we)..................................................................................................

hereby make application for a license authorizing me (us) to transact the business of a REAL ESTATE BROKER in compliance with the law regulating and licensing such business within the State of Michigan, and tender the FEE of $10.00 HEREWITH.

1. Name of applicant....................................................................

(If firm, give names of members; if partnership, give names of partners; if co-partnership, association or corporation, give officers.)

2. Business address (street and number)................................

(City or town)..........................................................................

(If more than one office, give address of each)...................

3. Residence (street and number)...........................................

(City or town)..........................................................................

4. If a firm, partnership or corporation designate ONE MEMBER of said firm, partnership or corporation to receive salesman's card under the license....................................................

3. Public Acts, Mich. 1921, No 387.

4. Public Acts, Mich. 1921, No. 387, Sec. 2.

5. What has been your business or occupation for past five years? Give places where continuous for sixty days or more........................................................................................._.........

6. Give references other than endorsers for each place stated in question five.....................................................................

7. Were you licensed as a Real Estate Salesman in 1920?

8. Have you been in any litigation over real estate during the past year?....................................................................................

State nature of complaint...........................................................

Signed (applicant)..............................................

(If applicant is firm or partnership, signer must give his relation to firm or partnership; if corporation, application must be signed by proper officers.)

Sworn to and subscribed before me a notary public in and for the county of........................State of Michigan, this................

day of........................................, 192.........

(Seal) ............................................................................................

My commission expires................................................

Recommendation (Two Endorsers Required.)

We, the undersigned, who are, and have been for a period of a year past, owners of real estate in the county of....................,

Michigan, do respectfully recommend for your consideration the application of..............................................................................

for a license as a Real Estate Broker.

We do hereby certify that we are well acquainted with the applicant(s) and also certify that he (they) has (have) a good reputation for honesty, integrity and fair dealing, and that we are satisfied that he (they) is (are) worthy of the license for which he (they) applies (apply).

Name..............................................................................................

Address ..........................................................................................

Name ..............................................................................................

Address ..........................................................................................