Fillable Printable Real Estate Appraiser Reciprocal License/Certification Application
Fillable Printable Real Estate Appraiser Reciprocal License/Certification Application
Real Estate Appraiser Reciprocal License/Certification Application
Real Estate Appraiser
Reciprocal License/
Certification Application
You can use this form to apply for a reciprocal real estate appraiser license/
certification.
If you are currently licensed/certified in good standing in another state, you
may be eligible to get a Reciprocal License/Certificate to practice real estate
appraisal in the state of Washington by meeting the requirements of
RCW 18.140 and WAC 308-125.
Send this completed form with a check or money order for the
$620 non-refundable fee, payable to Department of Licensing, to:
Real Estate Appraiser
Department of Licensing
PO Box 3917
Seattle, WA 98124-3917
Application type (choose only one):
Certified general
Certified residential
State licensed
Applicant
PRINT or TYPE Name (Last, First, Middle)Former name
Social Security number required* Date of birth (mm/dd/yyyy)
Mailing address (Street or PO Box, City, State, ZIP code)
Business name
Business physical address (Street, City, State, ZIP code)
(Area code) Telephone number (during normal business hours)
Email
*All applicants are required by federal and state law to provide their Social Security number (SSN) for use in child support enforcement programs
(42 U.S.C. 666(a)(13) and RCW 74.20A.320). It may also be used for education loan repayment programs and identification of records with similar
names. Submission of your SSN is mandatory; failure to submit it will result in denial of your application.
Licensing information
State of your active current license
Out-of-state license/certificate number State Out-of-state license/certificate number State
APR-622-184 (R/7/17)WA Page 1 of 2 continued on next page
Click here to START or CLEAR, then hit the TAB button
Personal data
Answer the following
If you answer “Yes” to any of the questions below, attach a detailed explanation on a separate 8-
1/2” x 11” sheet and
include official court documents.
In this state or any other jurisdiction, are you or have you:
1.With the last 10 years, had any action (fine, suspension, revocation, censure, surrender, etc.)
taken against any professional or occupational license, certification, or permit held by you?......... Yes No
2.Within the last 10 years, had any civil court order, verdict, or judgment entered against you? ........ Yes No
3.Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to
a gross misdemeanor or felony crime? (Don’t include traffic offenses) .......................... Yes No
4.Currently required to register as a sex offender?........................................... Yes No
If “Yes,” in which state and county
Certification
I authorize business associates (past and present) and any governmental agencies (local, state, or federal) to release
any information required for a background investigation by the Department of Licensing.
I agree to follow all the applicable laws and rules of this profession.
I understand that lawsuits or other actions may be filed against me in Washington and I consent that service of process
may be made by delivering it to the Director of the Department of Licensing.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
TYPE or PRINT name
Date and place Signature
APR-622-184 (R/7/17)WA Page 2 of 2
X
When you have completed this form, please print it out and sign here.
