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Date: ________________ The undersigned hereby applies for Owner Class A ___B___ D___C___E___ The Real Estate Board of New York, Inc. and subscribes to the Constitution and By-Laws of said Board and the Rules and Regulations governing the same, accepting and agreeing to be subject to them as they now exist or as they may be hereafter amended. The applicant agrees to pay the annual membership fees that apply to the class of membership to which he/she is an applicant as designated in the schedule herein contained: Signature of Applicant _____________________________________________________________________ Firm or Corporation ______________________________________________________________________ By _________________________________________________________ Business Address ___________________________________________________ Zip Code _____________ Bus. Tel:______________________ Fax:____________________ Email:__________________________ Have you ever been convicted of a felony or pleaded guilty to such an offense? Yes___ No___ If yes, please explain_____________________________________________________________________ Have you ever been convicted of a misdemeanor with respect to fiduciary responsibilities? Yes___ No___ If yes, please explain______________________________________________________________________ Principal Business _______________________________________________________________________ Representative __________________________________________________________________________ Address of Real Estate Owned ______________________________________________________________ Assessed value of property owned by applicant _________________________________________________ *Total amount of assets in dollars ____________________________________________________________ Proposed by _____________________________________________________________________________ Seconded by ____________________________________________________________________________ Indicate with an x whether the membership is to be in the name of the individual
or the company, co-partnership, (The owner of record assumes full responsibility for the payment of dues and all other obligations.) Individual___ Company, co-partnership, corporation or estate ____ (Extracts from the Constitution on Reverse Side of this Application.) *To be supplied by Institutional Owner Membership applicants. (Over)
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