"Renewal Application for Appraisal Management Company Registration & National Registry" - North Carolina

Renewal Application for Appraisal Management Company Registration & National Registry is a legal document that was released by the North Carolina Appraisal Board - a government authority operating within North Carolina.

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BOARD USE ONLY
NORTH CAROLINA
Amt Rec.
APPRAISAL BOARD
5830 Six Forks Road
Trans#
Raleigh, NC 27609
919-870-4854
www.ncappraisalboard.org
ncab@ncab.org
RENEWAL APPLICATION FOR APPRAISAL MANAGEMENT COMPANY
REGISTRATION & NATIONAL REGISTRY
TYPE OR PRINT CLEARLY IN INK. The renewal fee is $2000 and is NON-REFUNDABLE. Payment may be made by check,
but if the check is returned for insufficient funds, the renewal will be cancelled.
1
Company’s Name:
2
NC Registration Number:
2
Contact person for renewal:
3
Name
Telephone
Email
Has main address for company changed?
No ____ Yes ____ (Complete information below)
4
3
Street Address
City
State
Zip
PO Box (if applicable)
City
State
Zip
Telephone
Fax
Email
Send mail to Post Office Box
5
Has service of process agent changed?
No ____ Yes ____ (Complete information below)
Name
Street Address
City
State
Zip
Telephone
Fax
Email
1
BOARD USE ONLY
NORTH CAROLINA
Amt Rec.
APPRAISAL BOARD
5830 Six Forks Road
Trans#
Raleigh, NC 27609
919-870-4854
www.ncappraisalboard.org
ncab@ncab.org
RENEWAL APPLICATION FOR APPRAISAL MANAGEMENT COMPANY
REGISTRATION & NATIONAL REGISTRY
TYPE OR PRINT CLEARLY IN INK. The renewal fee is $2000 and is NON-REFUNDABLE. Payment may be made by check,
but if the check is returned for insufficient funds, the renewal will be cancelled.
1
Company’s Name:
2
NC Registration Number:
2
Contact person for renewal:
3
Name
Telephone
Email
Has main address for company changed?
No ____ Yes ____ (Complete information below)
4
3
Street Address
City
State
Zip
PO Box (if applicable)
City
State
Zip
Telephone
Fax
Email
Send mail to Post Office Box
5
Has service of process agent changed?
No ____ Yes ____ (Complete information below)
Name
Street Address
City
State
Zip
Telephone
Fax
Email
1
Has compliance manager changed? No ____ Yes ____ (Complete information below)
6
Name of Compliance Manager:
Date notification sent to Board:
7
Does the Company have an owner in whole or in part, directly or indirectly, that has had an
appraiser credential refused, denied, cancelled, surrendered in lieu of revocation, or revoked
in any state that was not previously reported to the NC Appraisal Board in connection with this AMC?
Yes
(Explain below)
No
_________________________________________________________________________________________
_________________________________________________________________________________________
(1)
Has any owner (who owns more than 10% of the Company) ever been convicted of or
8
pleaded guilty or no contest to any criminal offense in North Carolina or in any other state
that was not previously reported to the NC Appraisal Board in connection with this AMC?
Yes
No
Are there currently any criminal charges now pending against any owner (who owns more
than 10% of the Company) in North Carolina or in any other state that was not previously
reported to the NC Appraisal Board in connection with this AMC?
Yes
No
If either of the answers are “yes”, provide a copy of the court judgment and a release from probation or parole, if appropriate.
“Criminal offenses” and “criminal charges” include all criminal matters except speeding or parking violations. It
DOES include driving while under the influence of alcohol or drugs. If you believe a charge has been erased or
expunged, you must check with the appropriate court before completing this section.
9
a. Attach a new original Appraisal Management Company Registration Bond that expires no sooner than June 30, 2022
OR
b. Attach a copy of your current Bond that expires no sooner than June 30, 2022. If your Bond expires before that date,
you must obtain and attach an original continuation or rider to that Bond extending the date to at least June 30,
2022.
PUBLIC NOTICE STATEMENT required by N.C. Gen. Stat. §143-764(a)(5), effective December 31, 2017
Any worker who is defined as an employee by N.C. Gen. Stat. §§95-25.2(4) (NC Department Of Labor), 143-762(a)(3)
(Employee Fair Classification Act), 96-1(b)(10)(Employment Security Act), 97-2(2) (Workers’ Compensation Act), or 105-163.1(4)
(Withholding; Estimated Income Tax for Individuals) shall be treated as an employee unless the individual is an independent
contractor.
Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by Chapter 95, 96, 97, 105
or 143 of the General Statutes by misclassifying an employee as an independent contractor. Employees who believe that they
have been misclassified as an independent contractor by an employer may report the suspected misclassification to the Employee
Classification Section within the Industrial Commission. In making such a report, the employee shall provide the physical location,
mailing address, telephone number, and e-mail address where the alleged incidents of employee misclassification occurred. The
report shall be sent to the Employee Misclassification Section within the Industrial Commission.
Contact information for the Employee Misclassification Section:
Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
E-mail:
emp.classification@ic.nc.gov
Telephone: (919) 807-2582
Fax: (919) 715-0282
2
10
CERTIFICATION
The undersigned, in making this application for renewal to the North Carolina Appraisal Board for registration as an Appraisal
Management Company under the provisions of Chapter 93E of the General Statutes of North Carolina swears or affirms that he
(or she) has been designated by the Appraisal Management Company to make this application for renewal on their behalf, and
that all information provided in connection with this application for renewal is true to the best of his or her knowledge and belief,
with the understanding that any omissions, inaccuracies or failure to make full disclosures, or the return of a check for insufficient
funds, may be deemed sufficient reason to withhold renewal of or suspend or revoke a registration issued by the Board.
I certify that this Appraisal Management Company has a surety bond in the amount of $25,000 to secure compliance with
N.C.G.S. §93E-2-4(g) that will accrue to the North Carolina Appraisal Board for the benefit of a claimant against the registrant to
secure the faithful performance of the registrant's obligations and to a real estate appraiser who has performed an appraisal for
the registrant for which the appraiser has not been paid. I also certify that I have read the above Public Notice Statement and
have disclosed any investigations for employee misclassification and the result of those investigations.
SIGNATURE OF APPLICANT: ___________________________________________________________________________
Printed name: ______________________________________ Title: ______________________________________________
Date ___________________________
APPRAISAL MANAGEMENT COMPANY NATIONAL REGISTRY FEE WORKSHEET
In order to qualify for the AMC National Registry: if operating only in NC, you must have at least 16 panel appraisers licensed or
certified in North Carolina, OR if operating in multiple states, you must have at least 25 panel appraisers nationwide.
1
Operation Type (select one):
____ Single State (panel of at least 16 appraisers licensed or certified in North Carolina)
____ Multi-State (panel of 25 or more appraisers in two or more States)
Total Number of appraisers on the Company’s appraiser panel in North Carolina from January 1 to
2
December 31, 2020:
Total Number of appraisers on the Company’s appraiser panel nationwide from January 1 to
3
December 31, 2020:
Number of appraisers on the Company’s panel who performed one or more appraisals in connection
4
with a covered transaction in North Carolina from January 1 to December 31, 2020:
66
FEE CALCULATION:
TOTAL NUMBER OF APPRAISERS LISTED IN ITEM 4 ABOVE
___________
@ $25 PER APPRAISER
X
25.00
AMOUNT DUE FOR NATIONAL REGISTRY
___________
RENEWAL FEE
+
2,000.00
TOTAL DUE
___________
3
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