Instructions: Please answer all questions fully.

1. My Principal Business is:   Real Estate Broker
                                                   Other (specify)
2. My License is on INACTIVE STATUS .   I am an ASSOCIATE BROKER of another Broker .  
   I operate as an INDIVIDUAL BROKER , OR as a PARTNERSHIP , OR as a CORPORATION , OR as a LIMITED LIABILITY COMPANY ,  and AFFIRM that I maintain a REAL ESTATE TRUST ACCOUNT (S) in Nebraska and operate under the Business Name indicated above.
3. Please complete as applicable, either A, B or C below.
   (A)  PARTNERSHIP DATA
   If you operate as a PARTNERSHIP, list all Partners and their residence addresses:
   
   PARTNERSHIP NAME:
   (B)  CORPORATION DATA
   If you operate as a CORPORATION, list all Officers and their residence addresses:
   
   CORPORATION NAME:
   (C)  LIMITED LIABILITY COMPANY DATA
   If you operate as a LIMITED LIABILITY COMPANY and if the members have reserved any management rights, please list all members and their residence addresses.  Otherwise list manager (s) and their residence addresses.  Otherwise list  manager (s) and their residence addresses.
   LIMITED LIABILITY COMPANY NAME:
   

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4. My application for a license as a Real Estate Broker has not been rejected in this or any other State, nor has my license been revoked or suspended in this or any other state, except as follows:
   (You need not include any information which has been reported on previous applications.)
   
   (If no exception, please leave blank, otherwise, report in full in space provided above)
   
   
5. In addition to Nebraska, I am licensed in the following States:       (If none, please leave blank.)
   
   
   
6. If your answer to any of the following questions is YES, provide in box below: the names and last known addresses of all claimants, persons against whom claims were filed, and other parties involved; the name of the errors and omissions insurance carrier(s) for each licensee named; the location of the court, agency, or other entity with which such claim was filed (if applicable); the date such claim was filed and the caption and case cumber assigned to such claim; the nature of the claim and a brief statement of all significant facts and details.
   
   YOU MUST ANSWER EACH QUESTION, A-C.   (Answer A-C for yourself and/or the firm.)
   
   (A) Have there been any claims made against you or your errors and omission insurance carrier for errors and omission committed by you in the conduct of real estate activities since your last application?
   Yes No
   
   (B) Have any claims against you or your errors and omissions insurance carrier for errors and omissions arising from your real estate activities been settled since your last application?
   Yes No
   
   (C) Have any judgements been rendered against you by any court or agency for any claims filed against you or your errors and omission insurance carrier for errors and omissions arising from your real estate activities since your last application?
   Yes No
   
   

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7. If your answer to any of the following questions is YES, give the names of all parties involved, the court, location, date filed, nature of the suit and a brief statement of all significant details in box below. In supplying the following information, DO NOT INCLUDE Small Claims court Cases, Domestic Relations Court Cases, Automobile Accident Court Cases, or Traffic Court Cases. DO NOT INCLUDE MATTERS REPORTED IN THE PREVIOUS QUESTION REGARDING ERRORS AND OMISSIONS CLAIMS.
   
   YOU MUST ANSWER EACH QUESTION, A-D. (Answer A-D for yourself  and/or the firm.)
   
   (A) Have you been engaged in any lawsuits involving REAL ESTATE, either as Plaintiff or Defendant, since your last application?
   Yes No
   
   (B) Have you been names as a Defendant in any lawsuits since your last application?
   Yes No
   
   (C) Are there any lawsuits pending against you at the present time?
   Yes No
   
   (D) Have Judgements been rendered against you in any lawsuits since your last application?
   Yes No
   
   

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8. If your answer to any of the following questions is YES, give the court, location, date filed, charge, disposition, and a statement of all significant details in box below.
   
   YOU MUST ANSWER BOTH A AND B
   
   (A) Have you been convicted of any criminal offenses, other than minor traffic violations, since your last application?
   Yes No
   
   (B) Are there any criminal charges, other than minor traffic violations, pending against you at the present time?
   Yes No
   
   ERRORS AND OMISSIONS INSURANCE INFORMATION
   I am Renewing on ACTIVE STATUS and have (Check only ONE of the following.)
   
   1. Made application for Errors and Omissions Insurance under the Nebraska Commission-Offered Plan.
      
   2. Filed with the Commission Proof of Equivalent Coverage extending into 2002.
   3.   Filed with the Commission Proof of Equivalent Coverage for the calendar year 2002.
      
   I am requesting to be renewed on INACTIVE STATUS due to the fact that I will not be acquiring the Errors and Omissions Insurance at this time.
   

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   CONTINUING EDUCATION REQUIREMENT
   
   

   Non-resident licensees from the following states: AL, AR, CO, CT, GA, IA, ID, IN, KY, MA, MS, MT, NC, ND, NY, OH, OK, OR, SD, TN AND WY affirm the following: "The Continuing Education Requirement of my resident state, one of those listed above, is current."

   
   

   ALL OTHER LICENSEES must have submitted their Continuing Education Certificates to the Commission prior to submitting this form, if applicable.

   The foregoing statements are made for the purpose of renewing a Nebraska Real Estate Broker's License and I hereby consent that these statements may be used as evidence by the Real Estate Commission of the State of Nebraska, or in any court in Nebraska where a violation of the said Real Estate Law is claimed, and that the application and the statements herein made to said Real Estate Commission may, at any time, be used in evidence.

   RENEWAL APPLICATION AND FEES WILL BE RETURNED IF ALL REQUESTED INFORMATION IS NOT SUPPLIED AND/OR THIS APPLICATION IS NOT PROPERLY AND ELECTRONICALLY SUBMITTED BY THE APPLICANT.
   
   Social Security Number       Broker's Name
   
   

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   Business Telephone Number() -
   
   Home Telephone Number() -