STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 2 of 4 Form 531
3. STATEMENT OF DEVELOPER:
I, (name of owner or developer) , being first duly sworn on oath, say
that I am the owner and/or developer of the approved project known as
development with the Nevada registration number as #DEV. . The project named herein is situated in
the County of , State of .
I have personally investigated the record of (name of timeshare representative applicant)
who has made application to act as a Timeshare representative in the State of Nevada for me, and that from such
investigation it is my opinion that said applicant is honest, truthful, of good reputation, trustworthy, and competent to
act as a timeshare representative in such manner as to safeguard the interests of the public, and at the time of making
this affidavit, the application is fully complete and fully executed by the applicant. I hereby request and recommend
that a timeshare representative registration be granted and if the registration is issued, careful supervision over his/her
activities will be exercised by this developer/owner. Further certification is hereby made that the employment of such
applicant is actual and in good faith.
Signature of Owner or Developer:
Signed and sworn to (or affirmed) before me on (date) , by (print name of person taking oath)
.
State of
County of
Seal
Signature of Notary
4. CRIMINAL HISTORY AND OTHER INFORMATION: If your answer is Yes to any of the following questions,
you are required to attach the order of the court or agency, which was rendered as a result of the proceedings. In
addition, attach a written explanation that provides the full details, location, date, court charges, final disposition and
current disposition, when restitution was made, and any other pertinent information on an attached sheet.
Please check one box for questions a through g. If an error has occurred, you must initial the change.
a. Have you ever been a defendant in any litigation, administrative proceeding, or had any disciplinary action
against you held by a court or agency?
Yes No
b. Has any license issued to you by any public authority been denied, suspended, or revoked? If so, explain? Yes No
c. Has a surety company declined to be surety on any bond written on you in the two years prior to the date of
the application?
Yes No
d. Have you ever filed bankruptcy or has bankruptcy been filed against you? If filed within 7 years from the date
of this application, please provide a copy of the discharge.
Yes No
e. Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor? Yes No
f. Are you presently on parole or probation or paying any restitution? Yes No
g. Have you ever entered a plea of “nolo contendere” to a criminal action? Yes No
