Form COM-101 "Compliance Affidavit (Respondent and Broker Notarized)" - Arizona

What Is Form COM-101?

This is a legal form that was released by the Arizona Department of Real Estate - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 11, 2018;
  • The latest edition provided by the Arizona Department of Real Estate;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form COM-101 by clicking the link below or browse more documents and templates provided by the Arizona Department of Real Estate.

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Download Form COM-101 "Compliance Affidavit (Respondent and Broker Notarized)" - Arizona

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Arizona Department of Real Estate (ADRE)
DOUGLAS A. DUCEY
GOVERNOR
Enforcement & Compliance Division
www.azre.gov
LOUIS DETTORRE
COMMISSIONER
100 North 15
th
Avenue, Suite 201, Phoenix, Arizona 85007
COMPLIANCE AFFIDAVIT
(Respondent and Broker Notarized) (COM-101)
LICENSEE AFFIDAVIT
Licensee Name ___________________________
License #_________________
Print Name of Respondent
Consent Order Number: ___________________________
Consent Order dated _____________________
.e. = year F-DI-000
Commissioner’s Signature Date
i
I,_____________________________, hereby affirm that since the entering of the above Consent Order:
______ I have complied with all of the terms and conditions set forth in the above Consent Order.
initials
______ I have not violated any provision of the Title 32, Chapter 20 of the Arizona Revised Statutes.
initials
______ I have not violated any provision of the Title 4, Chapter 28 of the Arizona Administrative Code (Commissioner’s Rules).
initials
I declare under the penalty of perjury that the above statements are true. I agree to maintain the original signed Affidavit for 5 years.
___________________________________ ____________________ _
Respondent’s Signature
Date
State of Arizona
County of ___________________
The foregoing instrument was acknowledged before me, _________________, this ______ day of __________, ______,
by__________________________.
My commission expires: ___________________
_____________________________________________
NOTARY PUBLIC
DESIGNATED BROKER’S (DB) AFFIDAVIT
I,_________________________________, Designated Broker for the above named Respondent, have reviewed the above Affidavit,
Print Designated Broker Name
and attest to the fact that I, as the named Practice Monitor, continue to monitor the compliance issues of the above named
Respondent.
___________________________________
_________________________
______________
Designated Broker’s Signature
Designated Broker’s License Number
Date
State of Arizona
County of _____________
The foregoing instrument was acknowledged before me, _________________, this ______ day of __________, ______,
by__________________________.
My commission expires: ___________________
_____________________________________________
NOTARY PUBLIC
*For more information or questions visit
www.azre.gov
COM-101 rev 6-11-2018
Arizona Department of Real Estate (ADRE)
DOUGLAS A. DUCEY
GOVERNOR
Enforcement & Compliance Division
www.azre.gov
LOUIS DETTORRE
COMMISSIONER
100 North 15
th
Avenue, Suite 201, Phoenix, Arizona 85007
COMPLIANCE AFFIDAVIT
(Respondent and Broker Notarized) (COM-101)
LICENSEE AFFIDAVIT
Licensee Name ___________________________
License #_________________
Print Name of Respondent
Consent Order Number: ___________________________
Consent Order dated _____________________
.e. = year F-DI-000
Commissioner’s Signature Date
i
I,_____________________________, hereby affirm that since the entering of the above Consent Order:
______ I have complied with all of the terms and conditions set forth in the above Consent Order.
initials
______ I have not violated any provision of the Title 32, Chapter 20 of the Arizona Revised Statutes.
initials
______ I have not violated any provision of the Title 4, Chapter 28 of the Arizona Administrative Code (Commissioner’s Rules).
initials
I declare under the penalty of perjury that the above statements are true. I agree to maintain the original signed Affidavit for 5 years.
___________________________________ ____________________ _
Respondent’s Signature
Date
State of Arizona
County of ___________________
The foregoing instrument was acknowledged before me, _________________, this ______ day of __________, ______,
by__________________________.
My commission expires: ___________________
_____________________________________________
NOTARY PUBLIC
DESIGNATED BROKER’S (DB) AFFIDAVIT
I,_________________________________, Designated Broker for the above named Respondent, have reviewed the above Affidavit,
Print Designated Broker Name
and attest to the fact that I, as the named Practice Monitor, continue to monitor the compliance issues of the above named
Respondent.
___________________________________
_________________________
______________
Designated Broker’s Signature
Designated Broker’s License Number
Date
State of Arizona
County of _____________
The foregoing instrument was acknowledged before me, _________________, this ______ day of __________, ______,
by__________________________.
My commission expires: ___________________
_____________________________________________
NOTARY PUBLIC
*For more information or questions visit
www.azre.gov
COM-101 rev 6-11-2018