Real Estate License Live Scan Form – RE 237

CA DEPARTMENT OF REAL ESTATE (DRE) LICENSE LIVE SCAN REQUEST FORM

Call for fee

ContriButing agency

A0075

ORI (Code assigned by DOJ)

Agency Address Set.

California Department of real estate 1651 exposition BlvD, saCramento Ca 95815

E-mail code

09416

Application type

liCense, Certification, or permit

contact name

licensing section

Application title

real estate license

contact telephone number

1-877-373-4542

Applicant’s personal information

Applicant name (Last, First, & Middle initial)

Former name/AkA’s (Last, First)

DATE OF BIRTH

SEX

Male Female

HEIGHT

WEIGHT

EYE COLOR

HAIR COLOR

PLACE OF BIRTH

SOCIAL SECURITY NUMBER

CALIFORNIA DRIVER LICENSE/IDENTIFICATION NUMBER

Agency Billing number

residence Address (street/P.O. Box, City, state, Zip Code)

your OCA number (Use social security number)

level of service

live scan transaction

operator name

Date completed

transmitting Agency

Amount Collected (For Rolling Fee)

Amount collected (For dOJ/FBI Processing)

ATI number

Live Scan Resubmission Transaction

Original ATI number

Level of Service requested For Resubmission

California Department of Justice FBI