Enforcement Petition Application (RE 506), Rev 6/15 PBF506 Re506
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STATE OF CALIFORNIA — DEPARTMENT OF CONSUMER AFFAIRS EDMUND G. BROWN JR., Governor BUREAU OF REAL ESTATE IMPORTANT FEE NOTICE Petition Applications All petition applications are subject to the fees listed below. Please note that the fee is not refundable, does not guarantee approval of the petition and does not include the fee for a real estate license should the petition be granted. Petition fees For reinstatement or removal of restrictions: Salesperson Petition Fee .................... $800 Broker Petition Fee ............................ $800 Officer Petition Fee ............................ $800 Corporation Petition Fee .................... $800 When petitioning for the reinstatement or removal of restrictions for both an officer license and a related corporation, only one petition fee is required. Effective January 1, 2013, one set of classifiable electronic fingerprints is required as part of the petition process. Petition applicants must submit a completed copy of the RE 237 Live Scan Service Request with their petition application. Refer to RE 237B Fingerprint Information for details on the fingerprint fees and live scan providers. BUREAU OF REAL ESTATE PETITION PROCESSING UNIT (New 1/13) State of California Bureau of Real Estate Enforcement Petition Application Hearing Number RE 506 (Rev. 6/15) H– General Information Type or print all information clearly. Please refer to Privacy Notice on page 10. Answer all questions, indicating none or not applicable, if appropriate. The Petition will be evaluated in accordance with the Criteria of Rehabilitation, copy attached. Mail completed Petition to the nearest district office; addresses are listed on last page. Attach petition fee of $800 and completed RE 237 - Live Scan Service Request. Payment methods Acceptable payment methods — Cashiers’ check, money order, check or credit card. Make check or money order payable to: Bureau of Real Estate Credit card payments must be submitted with a Credit Card Payment (RE 909). Petition Information Petitioner Name Residence Address — Street Address, City, State, Zip Code Mailing Address — Street Address or Post Office Box, City, State, Zip Code Residence Telephone Number Business Telephone Number License Type Sales. 1. ID Number Broker List your residence addresses for the last five years. (List the most recent first.) From To Street Address, City, County Present 2. List employment and work since the formal hearing, or decision imposing discipline. (List the most recent employment first.) From To Present Name and address of Employer Position and Duties RE 506 3. Page 2 of 10 arrest/conviction — Have you ever been convicted of any violation of law? NO YES If YES, complete item 3b below. Note: "Conviction" includes a verdict of guilty by judge or jury, a plea of guilty or of nolo contendere, or a forfeiture of bail. All convictions must be disclosed whether or not the plea or verdict was set aside, the conviction against you was dismissed, or expunged or if you have been pardoned. Convictions occurring while you were a minor must be disclosed unless the record of conviction has been sealed under Section 1203.45 of the California Penal Code or Section 781 of the California Welfare and Institutions Code. 3a. Are there any criminal charges pending against you at this time? NO YES If YES, explain on page 9. 3b. List all arrests and convictions of law, including traffic. • Enter your statement on page 9 regarding each of the items listed below. • Attach additional sheets, if necessary. Date of Arrest 5/15/89 Arresting Agency and Address (Police, Sheriff, etc.) Sacramento City Police, 123 Main St, Sacramento S Charge Court of Conviction and Address (federal, municipal, superior, etc.) Sacramento Municipal Ct., 456 Main St., Sacramento A Petty Theft Conviction Type Section Number Violated Code Violated Case/Docket Number M Date of Conviction felony X misdemeanor 484 Penal Code 12345 P 6/15/89 — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. L Disposition Pled guilty; 6 months jail; work furlough; 1 year probation; $200 fine; $75 restitution Date Probation or parole Date pardoned or expunged, if any Was disclosure made to CalBRE? E Date Fines or restitution paid in full completed X YES NO–explain on page 9 9/1/89 6/15/90 7/15/90 #1 Date of Arrest Arresting Agency and Address (Police, Sheriff, etc.) Charge Court of Conviction and Address (federal, municipal, superior, etc.) Date of Conviction Conviction Type Section Number Violated Code Violated S A M P L E Case/Docket Number felony misdemeanor Disposition — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. Date Fines or restitution paid in full Date Probation or parole completed Date pardoned or expunged, if any Was disclosure made to CalBRE? YES NO–explain on page 9 #2 Date of Arrest Arresting Agency and Address (Police, Sheriff, etc.) Charge Court of Conviction and Address (federal, municipal, superior, etc.) Date of Conviction Conviction Type Section Number Violated Code Violated Case/Docket Number felony misdemeanor Disposition — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. Date Fines or restitution paid in full Date Probation or parole completed Date pardoned or expunged, if any Was disclosure made to CalBRE? YES NO–explain on page 9 Item 3B continued on page 3 RE 506 #3 Page 3 of 10 Date of Arrest Arresting Agency and Address (Police, Sheriff, etc.) Charge Court of Conviction and Address (federal, municipal, superior, etc.) Date of Conviction Conviction Type Section Number Violated Code Violated Case/Docket Number felony misdemeanor Disposition — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. Date Fines or restitution paid in full Date Probation or parole Date pardoned or expunged, if any completed Was disclosure made to CalBRE? YES NO–explain on page 9 #4 Date of Arrest Arresting Agency and Address (Police, Sheriff, etc.) Charge Court of Conviction and Address (federal, municipal, superior, etc.) Date of Conviction Conviction Type Section Number Violated Code Violated Case/Docket Number felony misdemeanor Disposition — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. Date Fines or restitution paid in full Date Probation or parole completed Date pardoned or expunged, if any Was disclosure made to CalBRE? YES NO–explain on page 9 #5 Date of Arrest Arresting Agency and Address (Police, Sheriff, etc.) Charge Court of Conviction and Address (federal, municipal, superior, etc.) Date of Conviction Conviction Type Section Number Violated Code Violated Case/Docket Number felony misdemeanor Disposition — Including whether pled guilty, nolo contendere, convicted, acquitted, sentence, fine, probation disposition and terms. Date Fines or restitution paid in full Date Probation or parole completed Date pardoned or expunged, if any Was disclosure made to CalBRE? YES NO–explain on page 9 RE 506 Page 4 of 10 4. Civil Court — Have you or any entity in which you had ownership, held an officer title, or exercised control ever been a defendant in any civil court litigation, including small claims court? NO YES If YES, give details below. In addition, please provide certified copies of all complaints and judgments. Failure to Provide th cause a delay in processing your Petition Application. Note: Cany court action may be grounds to deny your Petition. Attach additional sheets, if necessary. S A M P L E Date of Case 6/1/85 12345 Name of Plaintiff John Doe Name of Court and Address San Francisco Superior Ct., 123 Van Ness St, San Francisco Brief Description of civil complaint Misrepresentation and breach of fiduciary duty, failing to disclose a leaking roof Date of judgment Disposition of Litigation Has judgment been satisfied? If YES, give date 9/1/88 no #1 Case Number $10,000 judgment against defendant X yes Date of Case 12/1/88 Case Number Name of Plaintiff Name of Court and Address Brief Description of civil complaint Date of judgment Disposition of Litigation Has judgment been satisfied? no #2 If YES, give date yes Date of Case Case Number Name of Plaintiff Name of Court and Address Brief Description of civil complaint Date of judgment Disposition of Litigation Has judgment been satisfied? no #3 If YES, give date yes Date of Case Case Number Name of Court and Address Brief Description of civil complaint Date of judgment Disposition of Litigation Has judgment been satisfied? no yes If YES, give date Name of Plaintiff S A M P L E RE 506 Page 5 of 10 Comments: 4a. Past Due Debts — Do you have any past debts, outstanding judgments, or have you filed bankruptcy? NO YES If YES, explain below including efforts to discharge adjudicated debts or monetary obligations to others. If you have filed bankruptcy, please attach a certified copy of your initial bankruptcy filing, including the list of creditors, any discharge you may have received, together with copies of any adversary complaints and judgments that may have been filed in connection with your bankruptcy petition. 5. Restitution — Has restitution been made to any person who has suffered monetary losses through your acts or omissions, which formed the basis of the formal hearing or decision imposing discipline? NO Date YES If YES, provide details below. Name and Address of Party Amount Comments 6. Licenses — Do you hold or have you ever held any kind of license? NO 6a. YES If YES, state the type and purpose of the license and how long held. Has any type of license been denied, reprimanded, suspended, revoked, qualified, restricted or disciplinary action taken concerning any such license? NO YES If YES, explain below. 7. Business practices — If the discipline was related to business practices, explain what steps and efforts have been made toward correction. RE 506 Page 6 of 10 8. Alcohol/drugs/mental problems — If in part, the discipline was attributable to the abuse of alcohol/drugs or psychiatric/ emotional disturbances, is there still a continuing problem? NO 8a. YES Has psychiatric treatment or counseling ever been obtained? NO YES 8b. Are you now or ever been a member of A.A. or similar organization? NO YES If you answered YES to any of the above questions, please detail the extent and completion of rehabilitative action, if any, explaining who, what, where and how long. 9. Family — Check the appropriate box(es) below. Married more than once Married Divorced Single domestic partner Separated Do you have children? NO YES If YES, list how many and ages below: Number of Children: ___________ Ages: _________________________________________________________________________________________ If you have been divorced or separated and have children, do you or are you required to provide child support? NO YES If YES, are support payments current? NO YES If support payments are not current explain: RE 506 Page 7 of 10 10. Education — Mark the highest level of education completed. List name of college/university, any degrees, special or real estate related education or training courses completed other than private real estate school giving examination preparation work. High school graduate or equivalent College graduate Other (explain) 10a. Since disciplined, list any real estate related courses completed including continuing education courses, number of hours completed, and the dates the courses were completed. 11. Property Owned — Check the appropriate box(es) below. Own home Own other real property (describe below) Own car Own other property of substantial value (describe below) 12. Community Groups — Are you or have you been active in social, civic or community groups? NO YES If YES, describe the group and your extent of activity. 13. Military Service — Have you ever served in the military? NO YES If YES, list branch of service, length of service, rank/rating, whether any disciplinary action (i.e., court martial), and type of discharge including reason for separation. 14. Bonds — Have you ever been bonded? NO YES If YES, list the position , coverages, amount of bond, individual or blanket bond and if any claims ever made. RE 506 Page 8 of 10 15. Government Positions — Have you ever been employed by or given clearance by a government agency other than military service? NO YES If YES, specify type of position, duties, length of time employed and why separated. 16. Use space below to make any additional statement in support of your claim of rehabilitation. Attach letters from probation or parole officer, family members, business associates, clients, rehabilitation counselors or psychologists, etc., if any. RE 506 Page 9 of 10 Petitioner’s Statement Note: Statements relating to 3A and 3B are to be in the petitioner’s own handwriting. Certification The foregoing record of my arrests and convictions has been read by me and said record is true and correct. I hereby admit the truth of all facts and statements contained herein. The information submitted is for your consideration as part of my petition. I certify (or declare) under penalty of perjury that the foregoing is true and correct. I understand that the burden is upon me to show rehabilitation or other good cause for the granting of this petition; that no opportunity for oral argument will be given unless I am notified otherwise; and that this petition (including any attached papers) constitutes my opportunity to submit written argument. I understand that the $800 fee is not refundable and does not guarantee approval of my petition. Signature Date RE 506 Bureau of Real Estate District Offices Fresno District Office 2550 Mariposa Mall, Suite 3070 Fresno, CA 93721-2273 Los Angeles District Office 320 W. 4th Street, Suite 350 Los Angeles, CA 90013-1105 Oakland District Office 1515 Clay Street, Suite 702 Oakland, CA 94612-1462 Sacramento Principal Office 1651 Exposition Blvd. Sacramento, CA 95815 PO Box 137010 (mailing) Sacramento, CA 95813-7010 San Diego District Office 1350 Front Street, Suite 1063 San Diego, CA 92101-3687 Page 10 of 10 PRIVACY NOTICE: Section 1798.17 of the Civil Code requires this notice be provided when collecting personal or confidential information from individuals. Each individual has the right to review personal information maintained by this agency, unless access is exempted by law. Bureau of Real Estate 1651 Exposition Blvd. Sacramento, CA 95815 P. O. Box 137000 Sacramento, CA 95813-7000 Enforcement Telephone: (877) 373-4542 Article 3 of Chapter 3 (commencing with Section 10175), Article 4, Chapter 7 (commencing with Section 10560 of the Business and Professions Code) and Sections 14540 & 14740 et seq. of the Government Code authorizes the maintenance of this information. All requested information in this form is voluntary. Failure to submit all of the information requested on the enclosed form will impede the ability of the Commissioner to fully evaluate whether you meet the criteria of rehabilitation established pursuant to regulations of the Commissioner and the license sought may be denied. The lack of a satisfactory explanation as to the reason for not revealing a criminal conviction on your petition may result in a recommendation to deny the petition for reinstatement or removal of restrictions. The information requested in this form is primarily used for the purpose of aiding the Commissioner in evaluating the fitness of a petitioner with respect to the licensing matter at hand and may be used as an admission of the facts in an action brought to deny a petition. This information may be released as evidence at a hearing in Superior Court or to other governmental entities including Law Enforcement Agencies.
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