REALTOR® Inactive Status Form

Please submit this form if you or one of your agents plan to return their license to the state, we kindly ask that this form be completed to process your request.

Fields marked with an * are required.

First Name *

Last Name *

Phone *

Email *

License Number *

Office/Brokerage Name *

Office/Brokerage Mailing Address *

Requested Effective Date of Inactive Status *

Have you notified your broker *

I understand reactivation may require fulfillment of payment of applicable fees *

Signature *

Please verify that you have checked the “I'm not a robot” checkbox.