Enforcement Petition Application (RE 506), Rev 6/15 PBF506 Re506

User Manual: PBF506

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(New 1/13)
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
HEARING NUMBER
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ofce;addresses
are listed on last page.
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 ID NUMBER
SALES. BROKER
1. 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 NAME AND ADDRESS OF EMPLOYER POSITION AND DUTIES
PRESENT
PetItIon InformatIon
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).
State of California
Bureau of real eState
EnforcEmEnt PEtition APPlicAtion
RE 506 (Rev. 6/15)
RE 506 Page 2 of 10
3. 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 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 DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
#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 CASE/DOCKET NUMBER
FELONY
MISDEMEANOR
DISPOSITION — INCLUDING WHETHER PLED GUILTY, NOLO CONTENDERE, CONVICTED, ACQUITTED, SENTENCE, FINE, PROBATION DISPOSITION AND TERMS.
DATE FINES OR RESTITUTION DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
#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 DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
5/15/89 Sacramento City Police, 123 Main St, Sacramento
Petty Theft Sacramento Municipal Ct., 456 Main St., Sacramento
6/15/89 X 484 Penal Code 12345
Pled guilty; 6 months jail; work furlough; 1 year probation; $200 ne; $75 restitution
X
9/1/89 6/15/90 7/15/90
Item 3B continued on page 3
YES
NO–ExplaiN ON pagE 9
YES
NO–ExplaiN ON pagE 9
YES
NO–ExplaiN ON pagE 9
S
A
M
P
L
E
S
A
M
P
L
E
RE 506 Page 3 of 10
#3 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 DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
#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 DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
#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 DATE PROBATION OR PAROLE DATE PARDONED OR EXPUNGED, IF ANY WAS DISCLOSURE MADE TO CalBRE?
PAID IN FULL COMPLETED
YES
NO–ExplaiN ON pagE 9
YES
NO–ExplaiN ON pagE 9
YES
NO–ExplaiN ON pagE 9
RE 506 Page 4 of 10
6/1/85 12345 John Doe
San Francisco Superior Ct., 123 Van Ness St, San Francisco
Misrepresentation and breach of duciary duty, failing to disclose a leaking roof
9/1/88 $10,000 judgment against defendant
X 12/1/88
S
A
M
P
L
E
S
A
M
P
L
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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 THESE DOCUMENTS WILL CAUSE A DELAY IN PROCESSING YOUR PETITION
APPLICATION. NOTE: CONCEALING ANY COURT ACTION MAY BE GROUNDS TO DENY YOUR PETITION.
ATTACH ADDITIONAL SHEETS, IF NECESSARY.
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? IF YES, GIVE DATE
NO YES
#1 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? IF YES, GIVE DATE
NO YES
#2 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? IF YES, GIVE DATE
NO YES
#3 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? IF YES, GIVE DATE
NO YES
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 YES IF YES, PROVIDE DETAILS BELOW.
DATE NAME AND ADDRESS OF PARTY AMOUNT
COMMENTS
6. LICENSES — DO YOU HOLD OR HAVE YOU EVER HELD ANY KIND OF LICENSE?
NO YES IF YES, STATE THE TYPE AND PURPOSE OF THE LICENSE AND HOW LONG HELD.
6A. HAS ANY TYPE OF LICENSE BEEN DENIED, REPRIMANDED, SUSPENDED, REVOKED, QUALIFIED, RESTRICTED OR DISCIPLINARY ACTION TAKEN CON-
CERNING 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 YES
8A. 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, EX-
PLAINING WHO, WHAT, WHERE AND HOW LONG.
9. FAMILY — CHECK THE APPROPRIATE BOX(ES) BELOW.
MARRIED DIVORCED MARRIED MORE THAN ONCE SEPARATED
SINGLE DOMESTIC PARTNER
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 SER-
VICE?
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
SigNaturE DatE
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 notied 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.
Petitioner’s statement
NOtE: StatEmENtS rElatiNg tO 3a aND 3B arE tO BE iN thE pEtitiONEr’S OwN haNDwritiNg.
RE 506 Page 10 of 10
PRIVACY NOTICE: Section 1798.17 of the Civil Code requires this notice be provided
when collecting personal or condential 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 rehabilita-
tion 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 Com-
missionerinevaluatingthetness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.
Bureau of real estate
DIstrICt offICes
Fresno District Ofce
2550 Mariposa Mall, Suite 3070
Fresno, CA 93721-2273
Los Angeles District Ofce
320 W. 4th Street, Suite 350
Los Angeles, CA 90013-1105
Oakland District Ofce
1515 Clay Street, Suite 702
Oakland, CA 94612-1462
Sacramento Principal Ofce
1651 Exposition Blvd.
Sacramento, CA 95815
PO Box 137010 (mailing)
Sacramento, CA 95813-7010
San Diego District Ofce
1350 Front Street, Suite 1063
San Diego, CA 92101-3687

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