(Name of Subdivider)

, a subdivider
(street number)                                         (city)                              (state)                    (zip)

(name of broker)                                    (street number)                     (city)                 (state)       (zip)

representing broker, responsible for the subdivider's actions in the State of Nebraska.

The said subdivider certifies that, in compliance with the rules and regulations of the Nebraska Real

Estate Commission, all advertising, used by the subdivider in the State of Nebraska in promoting the

sales of subdivided lands, shall contain the name and address of the designated Nebraska Real Estate

Broker representing the subdivider in the State of Nebraska.
Submission of this Subdivider's Designation of Representing Broker verifies that all statements and information provided herein are true and correct and may be used as necessary by the Nebraska Real Estate Commission if furtherance of assuring compliance with the laws it regulates.
Dated                                                                                                                                            (Name of Subdiver or Subdivider's Authorized Representative)


as defined by Sections 81-885.01 (7) of the Nebraska Real Estate License Act hereby designates
a duly licensed Nebraska Real Estate Broker residing in the State of Nebraska, as the said subdivider's