Fillable Printable Real Estate Appraiser/Appraiser Trainee Renewal Affidavit
Fillable Printable Real Estate Appraiser/Appraiser Trainee Renewal Affidavit
Real Estate Appraiser/Appraiser Trainee Renewal Affidavit
Real Estate Appraiser/Appraiser
Trainee Renewal Affidavit
Real estate appraisers and appraiser trainees can use this form to prevent
the lapse of their license or certification.
Send this completed form, all required attachments, and your check or money
order payable to Department of Licensing, to:
Real Estate Appraiser
Department of Licensing
PO Box 3917
Seattle, WA 98124-3917
Appraiser – $530 non-refundable renewal fee. Include copies of course completion documentation for 28 hours of
continuing education.
Appraiser trainee – $200 non-refundable renewal fee. Include copies of course completion documentation for 28
hours of continuing education.
If your license, certification, or registration has expired, you must also include a $38 late fee payment.
TYPE or PRINT Applicant name (Last, First, Middle initial) License number
Answer the following
I
f you answer “Yes” to any of the following questions,
provide full details 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. Within 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”
to number 4, in which state and county
If your address, email, or telephone number has changed, please provide your updated information.
(Area code) New telephone number Email
New street address
City State ZIP code
New mailing address (if different)
City State ZIP code
I certify under the penalty of perjury that I have read, understand, and will comply with applicable laws and rules
(RCW 18.140 and WAC 308-125) and that I understand the penalties for misconduct. I also certify that the information
I have provided is true and correct to the best of my knowledge, and I understand that if I have provided any false
information, my license to provide appraisal services in the state of Washington may be denied, suspended, or revoked.
Date and place Applicant signature
APR-622-179 (R/1/17)WA
X
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When you have completed this form, please print it out and sign here.
