Criminal Conviction Reporting


An image of the North Carolin Real Estate Seal.

  1. 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.]
  2. To report a criminal conviction or disciplinary action, complete this form and return to the N.C. Real Estate Commission, Attn: Regulatory Affairs Division.
  3. Include with this form a certified 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. If you are reporting an N.C. conviction for impaired driving you should also include a copy of the Impaired Driving Determination of Sentencing factors (Form AOC-CR-311).
  4. For further information concerning reporting criminal convictions or disciplinary actions, contact the Real Estate Commission’s Regulatory Affairs Division, (919) 719-9180.

Personal Information

*
*
*
*
*
*
*
*
*
*
*
*
*
*

Disciplinary Action Details

*
*
*
*

Document Upload

Include with this form a certified 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.*
*Accepted File Types: .txt .pdf .docx .doc
*Max file upload size 5MBs.


Authorization

*

(Type your name)


You must complete the reCaptcha below before submitting this form*

3.83.87.94
An image of an exclamation point.

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.