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APPLICATION FOR RENEWAL
OF REAL ESTATE
SALESPERSON'S LICENSE NORTH DAKOTA REAL ESTATE COMMISSION
FOR OFFICIAL USE
Reeelpl No. 3 Q ll
Dtl Rod J -1 5- c; ,_,.. 3
314 EAST THAYER AVENUE- BOX 727
BISMARCK, NORTH DAKOTA 58502
SALES!lERSON FEE $40.00
1993
MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO NORTH DAKOTA REAL ESTATE COMMISSION
DEADLINE FOR RENEWAL- DECEMBER 31. 1992
Section 43-23-13, sub-section 3 of the North Dakota Real Estate License Law provides that all real estate licenses shall expire on the
thirty-first day of December of each year. Failure to remit this annual fee when due will automatically cancel such licenses.
If your license is currently held on "Inactive Status," write "Inactive" in line seven, complete the arplication, and submit with the
regular license fee.
Renewal fee must accompany this application.
Complete the following:
;J -f
Date
?_

1. Name of applicant:
Richard A Berg
(FIRST) (MIDDLE) (LAST)
2. Residence Telephone No. 293-9077

3. Residence Address: 1547 N 7th Street Fargo Cass ND 58102
(STREET NUMBER) (CITY) (COUNTY) (STATE) (ZIP)
4. Sex M
5. Post Office box number (If none, so specify): None
-----------------------------------------------------------------------------
(Note: This should be your own personal Post Office box)
6. Salesperson's license number: 3266

7. Firm or broker with whom you are associated: Midwest Management- MMC,Inc.

Name of broker (exactly as it appears on your license certificate) Example: John Jones dba Jones Realty
B. Business Address: 112 N. University Dr. Fargo ND 58102 235-2920
(STREET NUMBER) (CITY) (STATE) (ZIP) (TELEPHONE NO.)
9. QC] YES [ ] NO Are you now licensed as a real estate salesperson in any other state other than North Dakota? If yes, give the name
of state or states in which you are licensed and give business name under which you are licensed.
MMC,Inc.- Midwest Management- Minnesota
10. [ ] YES Has your application for a real estate broker or real estate salesperson been rejected in this or any other state or
has your license been revoked or suspended in this or any other state during 1992? If "Yes," when---------
and for what reason?
11. ( l YES r:] NO Have there been any civil lawsuits or arbitration proceedings in which you were involved either as plaintiff or
defendant in which fraud or misrepresentation was charged during the past year?
12. f l YES [X l NO
13. ( ] YES [X] NO
14. ( ] YES [X] NO
15. [ ] YES [X] NO
16. [ ] YES [X] NO
17. [ l YES [X] NO
Have you been engaged in any civil lawsuits or arbitration proceedings, either as a plaintiff or defendant, in-
volving the sale of real estate during the past year or are you now so engaged?
Have you. been charged with, arrested for, or convicted of a felony during the past year?
Have you been arrested, indicted or convicted of forgery, embezzlement, obtaining money under false pretenses, con-
version, issuing bad checks, extortion, criminal conspiracy to defraud, or other like offense during the past year?
Have you been a party defendant in any misdemeanor proceedings during the past year? (Do not include traffic viola-
tions.)
Have you been adjudged or filed bankruptcy during 1992?
Are there any judgments, arbitration awards, mechanics liens or federal or state tax liens against you, in North
Dakota or elsewhere?
If your answer is "YES" to No. 10 through 17, give details in a separate letter and attach to this application.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND THE ABOVE INFORMATION IS TRUE AND CORRECT, AND I HAVE COMPLIED
WITH ALL LICENSE REQUIREMENTS. I AM ALSO AWARE THAT ANY MATERIAL FALSE STATEMENT MADE ON THIS APPLICATION IS
GROUNDS FOR SUSPENSION OR REVOCATION OF MY LICENSE.

I CER Tl FY THAT f!u1 cud ..A- 16M if
STATE SALESPERSON.
(Check Application To See That All Questions Are Answered.)
Form No. 12168