Affidavit For Reinstatement Of Domestic Corporation Form. This is a Indiana form and can be use in Corporations Secretary Of State.
Tags: Affidavit For Reinstatement Of Domestic Corporation, 49514, Indiana Secretary Of State, Corporations
AD-19 Indiana Department of Revenue SF 49514 Afﬁdavit for Reinstatement of Domestic Corporation (R2/ 10-07) State of Indiana County of _____________ ) ) SS ) _________________________________________________ being duly sworn according to law, afﬁrms that he/she is the (name) ___________________________________________ of _______________________________ a corporation organized (ofﬁcial capacity) (corporation name) under the laws of the State of Indiana, _____________________________ , with its principal ofﬁce located at address (incorporation date) ____________________________________________________ , city _________________________ , state _________ , zip __________________ , and identiﬁed by Federal ID #_________________________________ , and Indiana sales and/or withholding tax TID # _____________________________________ and that he/she makes this afﬁdavit for and on behalf of this corporation. He/She states that the books and records of this corporation are kept at _______________________________________ , (address) in care of ________________________________________________ , and that this corporation is engaged in the business of (name) __________________________________________________________ . To the best of my belief and knowledge, all of (primary purpose) the said corporation’s Indiana taxable income received on and after May 1, 1933, has been included in Indiana income tax returns ﬁled with the Indiana Department of Revenue and that all tax has been paid. The latest Indiana sales and/or withholding tax return were ﬁled for the month/year ________/_________ , under the name of ___________________________________________ . (name) That this afﬁdavit is made for the sole purpose of inducing the Indiana Department of Revenue, to issue a notice as provided by the applicable taxing acts to the effect that such corporation has paid all taxes due from it under the taxing acts which will permit the Indiana Secretary of State to reinstate the corporation to active status. _______________________________________ Signature _______________________________________ Title State of Indiana County of _______________ ) ) SS ) Subscribed before me, a Notary Public in and for said county and state, this ____________ day of __________________ , _______ . __________________________________________________ _________________________________________________ Commission Expiration Date Signature __________________________________________________ _________________________________________________ County of Residence Printed Name Mail to: Indiana Department of Revenue, Tax Administration, Room N203, 100 N. Senate Avenue, Indianapolis, IN 46204. American LegalNet, Inc. www.FormsWorkflow.com