Any real estate broker who is convicted of a misdemeanor or felony criminal offense or who has had any disciplinary action taken
against him or her in connection with any other professional license (real estate or other) must notify the North Carolina Real
Estate Commission in writing within 60 days following the final judgment or final order in the case.
[Commission Rule A .0113,
eff. August 1, 1996, amended effective July 1, 2000.]
Upload with this form a copy of the judgment of the court or order of the licensing agency and a detailed statement
in your own words describing all relevant facts and circumstances surrounding the conviction/disciplinary action.
For further information concerning reporting criminal convictions or disciplinary actions, contact the Real Estate Commission’s
Regulatory Affairs Division, (919) 875-3700, ext. 131.
This form is not meant to be printed. If you have already completed the form please use the submit button at the bottom
to send the form directly to the Commission.