DBA-3 (01/01/2020)

Delegated Supervisor's Printed Name**

Texas Real Estate Commission P.O. Box 12188

Austin, Texas 78711-2188 www.trec.texas.gov (512) 936-3000

ONLY A BROKER MAY NOTIFY TREC OF USE OF AN ASSUMED BUSINESS NAME (DBA) THAT IS USED BY THE BROKER. ALL INFORMATION MUST BE COMPLETED AND TYPED OR PRINTED IN INK. THIS ASSUMED BUSINESS NAME (DBA) IS ASSIGNED TO THIS BROKER'S LICENSE.

LIST EACH ASSUMED BUSINESS NAME (DBA)

For each addition, broker should maintain a copy of any documentation permitting the use of each name.

License Number Expiration Date

Name on Broker's License

Mailing Address

City State Zip Code

Broker's Signature*

e-mail address Phone number

Name

NOTICE OF ASSUMED BUSINESS NAME (DBA) FOR A BROKER'S LICENSE

Add Delete

Check if changed from mailing address of record.

Date

*If Business Entity: printed name and signature of Designated Broker is required. ** Delegated Supervisor under 22 TAC §535.2(e).

Broker's Printed Name*

Date Delegated Supervisor's Signature**

DBA-3 (01/01/2020)

PRIVACY NOTICE In accordance with Chapter 559, Government code, the following notice about certain information laws and practices is given. (1) With few exceptions, an individual is entitled on request to be informed about the information that a state governmental

body collects about the individual. (2) Under Sections 552.021 and 552.023 of the Government Code, the individual is entitled to receive and review the

information. (3) Under Section 559.004 of the Government Code, the individual is entitled to have the governmental body correct information

about the individual that is incorrect