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VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SOC SEC# U.S. VI RG IN IS LANDS APPLICATION FOR APPRAISER LICENSE D Trainee Real Property Appraiser D Licensed Real Property Appraiser 0 Certified Residential Real Property Appraiser DCertified General Real Property Appraiser 0 State Registered Real Property Appraiser DATE OF APPLICATION DATE OF BIRTH PRESENTLY LICENSED IN VI: 0 Yes, Number 0No NAME HOME PHONE (last) (first) (middle) PREFERRED MAILING ADDRESS STATE ZIP RESIDENT ADDRESS FROM TO PRESENT STATE ZIP COUNTY PREVIOUS* ADDRESS FROM TO STATE ZIP COUNTY *Must show residen ce for last 3 years (attach sheet if needed) PRI NC IPAL PLACE OF BUSINESS Dcorp Osole Prop . 0Partnership COMPANY NAME BUS . PHONE FAX ADDRESS FROM TO STATE ZIP Type of Business Your Position ALL OTHER CURRENT PLACES OF BUSINESS** Dcorp . Oso le Prop . 0Partnership COMPANY NAME BUS . PHONE FA X ADDRESS FROM TO STATE ZIP Type of Business Your Position O;orp []sole Prop . 0Partnership COMPA NY NAME BUS . PHONE FAX ADDRESS FROM TO STATE ZIP Type of Business Your Position •• Must d etail all addresses at wh ich apprais al reports are be in g prepared (atta ch additio nal sheet if needed) OFFICE USE y N y N U .S . Citizen? .. . . . . . . . . . . . . . . . . . . . . . 0 0 High School Diploma .. . .. .... ..... ... .. .0 D App . Received Perm. Resident Alien? ....... .. ...... 0 0 GED? ... .. ... ..... ............. ..... 0 D Process Dale Naturalized Citizen? .. . 0 0 Processor Approval Date Felony Conviction? .. . 0 0 V .I. Licen se? . . . . . . . . . . . . . . . . ... ... . ....... € D D Fi li ng Date Misdemeanor Conviction? .. 0 0 USPAP C r edit? . .. ..... ............... .. . o D Filer VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SOC SEC # APPLICATION FOR APPRAISER LIC ENSE CI TIZEN SHIP STA T US Place of Birth (city) (county) (state ) (country) Other Status: If you are a naturalized citizen or permanent resident alien list date and DATE OF CITIZENSHIP place of achieving : (moldaylyear) 0Naturalized Citizen 0Permanent Resident Alien Place (city) (county) (state) Are you a current resident of the Virgin Islands? 0Yes0No During what periods of time have you been a resident of the Vi rgin Islands . From To From To From To From To Note : If you are NOT a resident of the U .S. Virgin Islands, you must com plete Page 8 Non -Resident Affidavit Form in this application. MINIMUM EDUCATIONAL REQUIREMENT Did you graduate from High School? Oves 0No Name of High School Date of Graduation (moldaylyear) Location Though I did not graduate, I attended the above school during the period From To Are you claiming the equivalent of a high school education (G EDJ?0Y es 0No Where was GED received? Date of Achieving GED (moldaylyear) (city) (county) (s tate ) CHARACTER/TR USTWORTHINESS Have you ever been con victed of a felony offense in the United States Virgin Islands ? 0 Yes 0N o Have you ever been convicted of a felony offense in another state or territory? 0Yes0No Have you ever been convicted of a felony offense in another country? 0 Yes0No Have you ever been convicted of a misdemeanor offense (excluding minor traffic violat ions) in the Virgin Islands? O es ON o Have you ever been convicted of a misdemeanor offense (excluding minor traffic violations) in another state? 0Y es 0N o Have you ever been terminated from employment due to moral turpitude or illegal acts? 0Yes0N o Has your license as real estate salesman or broker ever been revoked? 0 Yes 0No (Attach full e xplanation to all "yes " responses ab ove : Incl ude deta ils . facts. circumstances. loc ations. dates. and so fotth pettinent to each in stan ce reqwring a "yes" response.) (Attach additional sheets 1( necessary) VIRGIN ISLANDS ESTATE APPRAISERS BOARD SO C SE C # APPLICATION FOR APPRAISER LICENSE COMPETENCY REQUIREMENT Has your license or your application for license been rejected . revoked or surrendered in any state within 2 years ? .. (not c ounting failure to pass a w ri tten test) Has your membership in (or association with) any nationally recogn ized organization been revoked under Eth ics procedures of said appraisal organ ization : .. *If "yes", attach extra sheet of explanation . . Q Ye s * D No Under penalty of perjury , I hereby affirm that I am trustworthy and competent to transa ct the bus iness of an appra iser in a man ner that safeguards the public (date) KNOWLEDGE AND SPECIALIZED TRAINING BUSINESS SCHOOL, COLLEGE or UNIVERSITY Attended School City (Attach extra sheet if needed). {legal signature) State From SP EC IALIZ ED APPRAI SAL COURSES (M ust have bee n completed in last ten years ) Course Sponsor Location Hours From (Attach extra sheet if needed) To To Degree Exam Passed ? VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SOC SEC# APPL ICAT ION FO R APPRAISE R LICENSE EXPERIENCE REQUIREMENT (must be complet ed and signed ) The following provides evidence that I possess certain basic appraisal skills and that for a period of time I have or have not operate d as a re al est ate appraiser or review appraiser. Note: Applicants must also complete Page 6 wherein is contained data related to the completion of a Uniform Standards of Professional Appraisal Practice Course presented by an approved institution or appraisal organization . 1. Licensed Real Property Appraiser, (200 points): Certified Residential Real Property Appraiser , (250 points ), Certified General Real Property Appraiser. (30 0 points ) Applicants : I have at least the indicated experience in real property appraisal and can s upport this statement w i th written reports, file mem o randa , or other evidence satisfactory to the Board . ..0 2 . Licensed Real Property Appraiser : Certified Residential Real Property Appraiser; Certified General Real Property Appraiser Applicants : I understand that I must complete, under oath, Page 5 herein ; and may , upon request . be required to submit work samples (confidentiality between client and appraiser shall be mandated) ... ...... . ........... .. .... ... . ..... ... ..... .... ... ... .. .... . . ... ...... . . 0 3. Trainee Real Property Appraiser Appl icants : I do not have 100 points of experience , but detail my employm en t bel ow and my experience (i f any) on Page 5 . I understand I mu st complete Page 7 as well . .. .... .... .... ..... ....... .0 4 . State Registered Real Property Appraiser Applicants: I have at least 100 points of appraisal experience . which is docu mented on Page 5. I understand I must complete Page 7 as we ll .... 0 (date) (L egal Signature) EMPLOYMENT/EXP ERIENCE Employer (Company) Name - ----------------------- Is this a Branch or Subsid iary? 0Yes[] N o Your Position------------ Address _______________________________ _ Nature of Business ----------- From ________ To _____ _ Person who can verify employmenUexperience here ----------------------------------- Position - ------------- Address _____________________________ ___ __ Ph(____) Ph ( ___) (city) (slate) Employer (Company) Name------------------------ Is this a Branch or Subs id iary? 0 Ye Qo Your Position------------- Address ______________________________ _ Nature of Business ----------- From _________ To _ ____ _ Pers on who ca n verify employmenUexperience here --------------------------- -- Position --------------- Address ________________________________ _ Ph(___) Ph ( __ ) (city) (state) (zip) (Att ach addition al sh eet if needed) If any above is a bran c h or subsidiary, attach separate sheet showing data detailed above fo r main offi ce or corporate headquarters . THE DO CUME NTATION OF EXPERIENC E IS ON PAGE 5 AND MUS T BE FILLED OUT COMPLE TE LY . (Attach additional sheet if needed) Page4 -~irgin Islands Real Estate Appraiser Board c ppraiser Assignment Log (Please Print) .. C/) UJ .9 0 C/) c rn C/) ·u; ..., Pg No. __ " c 0 ·;n ·;n ~ C/) t1l 'E .9 ·;:: ..0 ·;n c:: ..., 0. >, t:: >, t1l Name: 41 0. ·c: t1l Cii <( Cii 0. of _ _ pgs &:1. ·c: (.) c c .:3 >( ::I (.) rn <: <: c:: v rn v UJ <( Certification , Licen se or Appren tice Number: f'1l v Cl c:i:3 v v c ..r:: I Cl rn (il rn 0 (.) c:i:3 c:: ~ (/) v ·;:: t1l f'1l c:i:3 0 rn Cii .~ ..., c:: ·.::: ..., 0.. ·;n ..., Signature: Date Signed: rn E rn U) t1l c:: 0 0. II) >, ·;n - (.) 41 .9 ·;:: ·c: !ll 0 Cii 2 c v >, rn u ..., u u u c Cii 0 t1l Hours Requested: This page Total - u v rn c:i:3 ...... <: tlO u ~ .... v 0. II) 0 .s ~ 0. rn Cl ..., c v 0. .r:: v <: 0:: 41 rn .s (/) u E c Applicants must enter actual hours, subject to maximums permitted in Board rules. .. .s -a v .... ..., t1l Cii .... &:1. tlO ..r:: ..r:: 03 0 rn II) II) &:1. II) 32 .D tlO v u 0 ~ c ..r:: Rev 6/08 < i UJ ..5 u Report Report Type of ..., z v 6: ..., Subject Address Client Est. Market I U) !ll Ck: 0 Applicant Type Property ;::: - Date Value < - > > > > ~ x .....; - - Hours A s r- A s A s A s .... .. . ----··· ······- -······ ······- -······ ....... ... .. .. ---- -·· ·····-- A s . ... ... ----··· ····--· ....... ···--·- ······· ....... ··-···· . .... .. ······- A ·-- s ...... ·---··- ······- ---···· ·------ ------- ···-··· ······- ------- · ·-- -·· A s ······ - ------. ·····- . ...... . ····----····· . .. .... . ······ . --- --- · ····-·- A s ··---- . ··--·· . ...... .. .. .. . . .. ... . . -······ . ..... . .... .. . ·----· . . .. ... . A s ······ ....... . ·--- -· . ...... . ···--- . ...... ... .. . . . ..... . ..... . . ... ... . 1-A. ··- - -- · - ···--- ··--· ·····- ·- ··· ... .. ·····- .... .. . ....... s ---------------------~ PE!L!~e!~ ~~~~£~E-~~e-=~--§~~-~~~~-~ -§~~~~~~~~~~=§-~ ---------------------------------------------- ----- l Apprentices only must: Appraisers who are not now Appentices do not need to complete columns I thru X I I 11) Indicate to which portio ns of the assignment they contributed by putting an "x" in Columns I thru X . 1 I I l 2) Prepare a separate log for each month and have their supervisors follow instructions 3 & 4 belo w. l l 3) For eac h portion of e ach assignment , Supervisors must indicate whether they : P- Had Prim ary Responsibil ity C- Co-apprai sed R - Re vie wed and Ap prove d l I 1 l4) Supervisor Name (Print) Supe rvi sor 's lic /Cert No . l I I t _________ ~u~~~Ls2I-~-~!1~~~1---------------------------------------------------- -------------- -~~~-~~~~~-------- ----------- J VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SOC SEC# Acknow ledge ment of Respons ibilities of Supervising Appraiser If a supervisory appraiser signs the appraisal report(s) of a trainee , he or she certifies and agrees that "I directly superv ised the trainee appraiser who prepared the appraisal report(s), h ave reviewed the appraisal report(s) , agre e with the st ate ments and conclusions of the trainee appraiser, agree to be bound by the appraiser's certification and the Unifor m Standa rds of Professional Appraisal Practice , and am taking full respo nsibility for the appraisal(s) and the appraisal report(s) ." I acknowledge that I have performed the responsibilities of supervising appra iser for the appraisals on the Assignment log of---------- - ---- (Trainee) Signed ___ _________________ _ Classification No . ------------ ----- Date--------------------- (Separate log for each supervising appraiser is required) TRAINEE 5-19- 94 VIRGIN IS LANDS REAL ESTATE APPRAISERS BOARD SOC SEC# APPLICATION FOR APPRAISER LICENSE UNIFORM STANDARDS O F PROFE SSIONAL APPRAISAL PRACTICE COU R SE 1 am providi ng evidence below of having passed withi n 24 months prior to the date of this application, a Unifo rm Standa rds of Profess ion al Appraisal Practice Course* Course Date to month day year month day year Board Course Title Sponsor Location State Approved? I I I I I *Attached are copies of my evaluation sheet and the certificate of completion, a nd stateme nt of passing grade that I received for this course. APPLICANT AFFIDAVIT 1 certify that all information in this application is true to the best of my knowledge and that I have com pleted thi s ap plic atio n in fait hful reflectio n and observation of facts as they are known to me. I further pledge to comply with the standard s set fort h by the US VI Rea l Estate Apprai sers Acts and the regulations therein and understand the types of misconduct for which discipline pro ceed in gs may be ini t iated against me . I understand all statements may be verified by the Board and I agree to comply with all requests to p ro duce such mate ria ls or other documentation as may be required of the Board to confirm my statements or otherwise esta blish the truthful ness of my app lic at ion . IN WIT NE SS THEREOF I have hereunto set my hand and seal this ___ day of ____________ _ _ ,20 __ (legal signature) UNITED STATES V IRGIN ISLANDS IS LA ND OF 1 the undersigned authority, a Notary P ublic in a nd for the U. S VI., hereby c ertify that the above app licant , -,------:----:-:--::---------:-:--:----:-- , whose nam e is signed to the foregoin g conveya nce , and who is known to me, acknowledged before me on this day, that, be ing inform ed of the contents of this application (he) (she) has executed the sam e voluntarily on the day the same bea rs date. My Seal Given under my hand a nd official seal this __ day of _______ _ (Notary Public) M y commission expires _______ _ , 20 __ ,20 __ I VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SOC SEC# APPLICATION FOR APPRAISER LICENSE NON - RE SI DE NT FO R M Name ____________________________________________________________ ___ PREVIOUS* ADDRESS PREVIOUS* ADDRESS ----------------------------------------- From _________________ To __________________ _ _________ STATE _____ ZIP _____ COUNTY ____________ _ __________________________________________ From ___________________ To __________________ _ _________ STATE _____ ZIP ______ COUNTY _____________ _ *Must show residence for additional 2 years, total of 5 (see Page 1) OTH E R LI C E NSE S , ET C . List all states with which you now have an APPRAISER'S License (L), Certification (C), or Registration (R) State R L c (Attach additional sheet if necessary) NO N-RE SIDE NT AFFIDAVIT Year (Office use) Reciprocity? State R L c Ye ar (Office Use) Reciprocity? I, as a non-resident applicant for an appraisal license (and as a licensee), agree that the US. Virgin Islands & the V.I. Rea l E state Appraisers Board shall have jurisdiction over me in any and all of my real estate activities the same as if I were a V.I. resident licen see. 1 agre e to be subject to invistigations and disciplinary actions the same as V.I. resident licensees. Further , I agree that civil actions m ay be co m menced against me in a ny court of competent jurisdiction in any court of the United States Virgin Islands. I hereby appoint the Administrator of the Virgin Islands Real Estate Appraisers Board as my agent upon whom all disciplin ary , ju d ici al , or other process or legal notices may be served. I agree that such service upon my said agent shall be the same as service up on me and tha t ce rtified copies of this appointment shall be deemed sufficient evidence thereof and shall be admitted into evidence with the sam e force and effect as the original might be admitted . I agree that any lawful process against me which is served upon my said agent shall be of th e sam e le gal forc e an d validity as if personally served upon me and that this appointment shall continue in effect for as long as I have any liability as a n appra iser rem ai nin g in the U.S. Virgin Islands. I understand that my said agent shall, within a reasonable time after service upon him or her. ma il a co py of sa me b y certified mail, return receipt requested, to me, at my last known business address. I agree that I am bound by all the provisions of the U.S. Virgin Islands Real Estate Appraisers Act. Legal Signature of Applicant PHOTO ATTACHMENT ~ --- - ----- ----- --------- -------------- ----- --------------------------------------------- -- - ------------- . (affix photo here) • I ~ ----- ---- ----------------------- - ------- - -------------------- - -------- - ------------ - -- -- - - -------------- ' A ttac h a re c en t photo grap h th at is less than 6 m o nth s old . Include the date taken below . month day year * Must be original legible picture VIRGIN ISLANDS REAL ESTATE APPRAISERS BOARD SSOC SEC # A PPLICATION FOR APPRAISER LICENSE REFERENCES ATTACHM ENT List at least five references who (1) know you personally, & (2) will attest to your possessing the required experience, ability, character and repu ta tion . You ma y include as references, persons shown as employer on Page 4 but you must show them below . NOTE : At least three referen ces mu st cu rrently be licen sed as a "Licensed Real Property Appraiser" , "Certified Residental Real Property Appra iser" . or a "Certified General Re al Property App rai ser" in the U .S.V.I. (or the equivalent in the state of residence) . (If necessary , Trainee applicants may include non-appraisers as referen ces .) REFERENCE #1 ; License/Certififcation Number Name Phone Company Company Address Home Address Signature of reference Date REFERENCE #2; License/Certififcation Number Name Phone Company Company Address Home Address Signature of reference Date REFERENCE #3 ; License/Certitifcation Number Name Phone Company Company Address Home Ad dress Signature of reference Date Note : References dated more than one year prior to date application is received by the Board will not be cou nted. Signature of reference Date Note : References da ted more than one year prior to date applicatio n is received by the Board will not be counted .