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APPLICATION FOR RENEwAL

OF REAL ESTATE
LICENSE NORTH DAKOTA REAL ESTATE COMMISSION
FOR OFFICIAL USE
Aocolpl Ho. __
Dolo Aonowod /- 9-9 r
314 EAST THAYER AVENUE- BOX 727
BISMARCK, NORTH DAKOTA 58502
SALESPERSON FEE $40.00
"'1995
MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO NORTH DAKOTA REAL ESTATE COMMISSION
DEADLINE FOR RENEWAL- DECEMBER 31. 1994
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Section 43-23-13
7
sub-section 3 of the North Dakota Real Estate License Law provides
that all real estate licenses shall expire on the thirty-first day of December of each
year. Failure to remit this annual fee when due will automatically cancel such licenses.
If your license is currently held on "Inactive Status"
7
write "Inactive" in line seven
7
complete the application
7
and submit with the regular license fee.
Renewal fee must accompany this application.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Complete the following:
Date December 28 1
9
94
1. Name of applicant: Richard A. Ber
(FIRST) (MIDDLE) (LAST)
2. Residence Telephone No. 293-9077
------------------------
3. Residence Address:6437 13th St. N,
(STREET NUMBER)
Fargo
(CITY)
Cass
(COUNTY)
ND
(STATE)
58102
(ZIP)
4. __ N_o_n_e ____________________________________ _
(Note: This should be your own personal Post Office box)
5. Salesperson's license number:
6. Firm or broker with whom you are associated: GOLDMARK Property Management, Inc.
Name of broker (exactly as it appears on your license certificate) Example: John Jones dba Jones Realty
7. Business Address: 1112 Nodak Drive Ste. 200 Fargo ND
(STATE)
58103
(ZIP)
235-2920
(TELEPHONE NO. )
8. [ ] NO
9. [ ] YES
(STREET NUMBER) (CITY)
Are you now licensed as a real estate salesperson in any other state other North Dakota? If yes, give the name
of state or states in which you are licensed and give business name under which you are licensed.
Minnesota - Midwest Management
Has your application for a real estate broker or real estate salesperson been rejected in this or any other state or
has your license been revoked or suspended in this or any other state during 1994? If "Yes",
and for reason? ---------
10 [ ] YES [v{ NO Have there been any civil lawsuits or arbitration proceedings in which you were involved either as plaintiff or
defendant in which fraud or misrepresentation was charged during the past year?
11. [ ] YES rvf"No
12. [ ] YES
13. [ ] YES
14. [ ] YES
15. [ ] YES
[z
16. [ ] YES [ NO
Have you been engaged in any civil lawsuits or arbitration proceedings, either as a plaintiff or defendant, in-
volving the sale of real estate during the past year or are you now so engaged?
Haveyou.been charged with, arrested for, or convicted of a felony during the past year?
Have you been arrested, indicted or convicted of forgery, embezzlement, obtaining money under false pretenses, con-
version , issuing bad checks, extortion, criminal conspiracy to defraud, or other like offense during the past year?
Have you been a party defendant in any misdemeanor proceedings during the past year? (Do not include traffic viola-
tions.)
Have you been adjudged or filed bankruptcy during 1994?
Are there any judgments, arbitration awards, mechanics liens or federal or state tax liens against you, in North
Dakota or elsewhere?
IF YOUR ANSWER IS ''YES" TO ImMBER 8 mROUGH 16
7
GIVE DETAILS IN A SEPARATE LE'.ITKR AND ATTACH TO THIS APPLICATION.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND THE ABOVE INFORMATION IS TRUE AND CORRECT, AND I HAVE COMPLIED
WITH ALL LICENSE REQUIREMENTS. I AM ALSO AWARE THAT ANY MATERIAL FALSE STATEMENT MADE ON THIS APPLICATION IS
GROUNDS FOR SUSPENSION OR REVOCATION OF MY LICENSE.

(SALESPERSON' S""""S""fG"NATUREe::::J
I CERTIFY THAT Richard A. Berg SOCIATED WITH ME Rul E ATE

SALESPERSON.
SIGNATURE)
(Check Application To See That All Questions Are Answered.)
Form No. 12168