Form REPL-19-0001 Federally Regulated Appraisal Management Company Application - Ohio

Form REPL-19-0001 is a Ohio Department of Commerce form also known as the "Federally Regulated Appraisal Management Company Application". The latest edition of the form was released in February 1, 2019 and is available for digital filing.

Download an up-to-date Form REPL-19-0001 in PDF-format down below or look it up on the Ohio Department of Commerce Forms website.

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Federally Regulated Appraisal Management Company
Application
For Division Use Only
Section 1: Appraisal Management Company Information
Legal Name of Company
Federal Tax ID Number
Doing Business as Name
Principal Business Phone
Principal Business Address
Principal Business Fax
City
State
Zip Code
Ohio Secretary of State Entity Number
Email Address
Company Business Structure (Check One)
 Corporation  LLC  Partnership  Sole Proprietor
Number of Years in Existence
State of Domicile
Section 2: Responsible Party Information
First Name
Middle Initial
Last Name
Mailing Address
City
State
Zip Code
Email Address
Phone Number
Ethical and Legal History Questions
(To be completed for the Appraisal Management Company)
Please attach any materials or explanations to this application for any questions answered yes.
Is the federally regulated AMC in whole or in part, directly or indirectly owned by a person


YES
NO
who has had an appraiser credential refused, denied, cancelled, surrendered in lieu of
discipline or revoked in any state?
* For any court or case related material, please provide the name of the court or adjudicatory body and the case number.
Materials or explanations may include, but are not limited to copies of the following: adjudication orders, investigation
notices and credential denial notices issued by an agency; or final judgment entries.
Division of Real Estate &
Phone 614-466-4100
Professional Licensing
Fax 614-644-0584
77 South High Street
TTY/TDD 800-750-0750
th
20
Floor
com.ohio.gov/real
Columbus, Ohio 43215
Anne M. Petit, Superintendent
REPL-19-0001
Rev. 2/2019
An Equal Opportunity Employer and Service Provider
Page 1 of 2
Federally Regulated Appraisal Management Company
Application
For Division Use Only
Section 1: Appraisal Management Company Information
Legal Name of Company
Federal Tax ID Number
Doing Business as Name
Principal Business Phone
Principal Business Address
Principal Business Fax
City
State
Zip Code
Ohio Secretary of State Entity Number
Email Address
Company Business Structure (Check One)
 Corporation  LLC  Partnership  Sole Proprietor
Number of Years in Existence
State of Domicile
Section 2: Responsible Party Information
First Name
Middle Initial
Last Name
Mailing Address
City
State
Zip Code
Email Address
Phone Number
Ethical and Legal History Questions
(To be completed for the Appraisal Management Company)
Please attach any materials or explanations to this application for any questions answered yes.
Is the federally regulated AMC in whole or in part, directly or indirectly owned by a person


YES
NO
who has had an appraiser credential refused, denied, cancelled, surrendered in lieu of
discipline or revoked in any state?
* For any court or case related material, please provide the name of the court or adjudicatory body and the case number.
Materials or explanations may include, but are not limited to copies of the following: adjudication orders, investigation
notices and credential denial notices issued by an agency; or final judgment entries.
Division of Real Estate &
Phone 614-466-4100
Professional Licensing
Fax 614-644-0584
77 South High Street
TTY/TDD 800-750-0750
th
20
Floor
com.ohio.gov/real
Columbus, Ohio 43215
Anne M. Petit, Superintendent
REPL-19-0001
Rev. 2/2019
An Equal Opportunity Employer and Service Provider
Page 1 of 2
Section 3: National Registry Fee
2a.
In the last 12 months immediately preceding the date of this application, how many
appraisers were on your appraiser panel* for covered transactions** located within
the state of Ohio?
2b.
In the last 12 months immediately preceding the date of this application, how many
appraisers were on your appraiser panel* for covered transactions** located
outside the state of Ohio?
AREA INTENTIONALLY LEFT BLANK
* “Appraiser panel” means a network, list or roster of licensed or certified appraisers approved by an AMC to perform appraisals as independent
contractors for the AMC.
** “Covered transaction” means any consumer credit transaction secured by the consumer’s principal dwelling.
An appraiser is deemed part of the AMC’s appraiser panel as of the earliest date on which the AMC: (1) Affirms acceptance of the appraiser for the
AMC’s consideration for future appraisal assignments in covered transactions or for secondary mortgage market participants in connection with
covered transactions; OR (2) Engages the appraiser to perform one or more appraisals on behalf of a creditor for a covered transaction or secondary
mortgage market participant in connection with covered transactions.
For an appraiser to be removed from an appraiser panel, the AMC must send written notice to the appraiser removing the appraiser from the
appraiser panel, with an explanation of its action; OR the AMC must receive written notice from the appraiser asking to be removed from the
appraiser panel or notice of the death or incapacity of the appraiser.
If an appraiser is removed from an AMC’s appraiser panel pursuant to the previous paragraph, but the AMC subsequently re-admits or engages the
appraiser at any time during the twelve months after the AMC’s removal, the removal will be deemed not to have occurred, and the appraiser will be
deemed to have been part of the AMC’s appraiser panel without interruption. (12 CF.R. Section 323.9)
Section 4: Certification
The undersigned affirms he or she has been designated or is duly authorized by the AMC to act on its behalf and all
information provided in connection with this application is true and accurate. Any false information on this application
may subject the undersigned to criminal prosecution. The undersigned states this application gives the division notice of
this AMC’s intent to provide appraisal management services in the state of Ohio and hereby gives consent by the AMC
to provide any assistance to the division necessary for the processing of this application.
Print Name of Responsible Party
Signature of Responsible Party
Date
Sworn to and subscribed before me, a notary public, this
day of
20
.
(Notary Seal)
Signature of Notary
Division of Real Estate
Phone 614-466-4100
& Professional Licensing
Fax 614-644-0584
77 South High Street
TTY/TDD 800-750-0750
th
20
Floor
com.ohio.gov/real
Anne M. Petit, Superintendent
Columbus, Ohio 43215
REPL-19-0001
Rev. 2/2019
An Equal Opportunity Employer and Service Provider
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