As is stated in Title 299, Chapter 2, Section 001:

"It shall be presumed that a duly licensed broker whose principal business is other than that of a real estate broker is unable to supervise licensed employees and said broker shall not be allowed to employ a real estate salesperson or an associate broker until such presumption is overcome by satisfactory evidence to the contrary."

Please complete the following form in order to supply important information necessary to consider in overcoming the presumption detailed above. 


1.    Name of broker licensee making request

2.     Name of Real Estate Business for which you wish to become the designated broker:

3.     Address of the Real Estate business named in Number 2:

4.     Name and Address of your principal business:

5.     How far apart are these businesses? (miles)

6.     Number of proposed licensees in the real estate business named in Number 2?

        a.     List name (s) of proposed licensee (s) if other than an already established real estate business:

7.    Describe, in detail, your accessibility to these proposed licensee (s):

        a.     By Telephone:   

        b.     In Person:

8.      Describe, in detail, below, the extent and manner of your supervision to these proposed real estate licensee(s).

9.     Describe, in detail, your accessibility to consumers of your proposed real estate services:

        a.        By Telephone: 

        b.         By Mail:

        c.         In Person:

        d.         Identification of Office to Public:

        e.         Location of Records:

10.      To what extent does your principal employer, if other than yourself, approve your involvement in
           this proposed real estate business and support your accessibility? (A letter of acknowledgement from the
           principal employer explaining his/her perception of what you are proposing and supporting your
           availability, as described above, must be submitted before survey is processed.)

Submission of this Survey to Address the Presumption in Title 299, Chapter 2, Section 001 Nebraska Real Estate Commission Rules 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.

Broker's Name