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Fillable Printable Form 13215

Fillable Printable Form 13215

Form 13215

Form 13215

Page 1 of 3
APPLICATION FOR VEHICLE OR WATERCRAFT
DEALER BUSINESS LICENSE
State Form 13215 (R13 / 6-15)
Approved by State Board of Accounts, 2015
CONNIE LAWSON
SECRETARY OF STATE
DEALER DIVISI ON
302 W. Washington Street, Room E018
Indianapolis, Indiana 46204-2700
Telephone: (317) 234-7190
Fax: (317) 233-1915
www.sos.in.gov
Go to www.in.gov/sos/dealer for a list of required documents.
NOTE: The person or officer with jurisdiction over the real property described on this form must verify compliance with zoning and local ordinances in
the relevant section below. If there is no person or officer with jurisdiction over the real property, you must include a written statement to that effect from
the executive of the unit in which the property is located. The statement must state that the proposed location is zoned for the operation of the type of
business described in this application.
1. Name in which the business license will be issued
2. Federal identification number (FIN)
3. Daytime telephone number
( )
Evening telephone number
( )
Fax number
( )
E-mail address
4. Legal address of business (number and street)
City
State
ZIP code
County
5. Tax identification number
Location number
6. The business location is:
Leased Owned
If leased, name of lessor
Address of lessor (number and street)
City
State
ZIP code
Telephone number of lessor
( )
7a. Name of insurance carrier
Policy number
Date of expiration (month, day, year)
7b. Name of bond carrier
Bond number
Effective date of bond (month, day, year)
8a. Type of dealer (check one)
Vehicle Watercraft
8b. Indicate the type of license being applied for by checking the appropriate box.
Dealer DistributorConverter Manufacturer Watercraft Dealer
Manufacturer Automobile Auction Mobility Dealer Transfer Dealer
9. If applying for a LICENSE, indicate the type of vehicles sold by checking the appropriate box(es).
CARS TRUCKS MOTORCYCLES MOBILE HOMES TRAILERS RECREATIONAL ALL TERRAIN BOATS OTHER
New Only New Only New Only New Only New Only VEHICLES VEHICLES (ATVs) New Only New Only
Used Only Used Only Used Only Used Only Used Only New Only New Only Used Only Used Only
New & Used New & Used New & Used New & Used New & Used Used Only Used Only New & Used New & Used
MDCANew & Used New & Used
MDC B
If you checked Other, please explain.
10. Number of full-time sales persons directly
involved with selling
11. Number of other full-time employees
12. How many units do you expect to sell during the next twelve (12) months?
Wholesale Retail
13. Type of applicant (check one)
a. Sole proprietorship b. Partnership c. Corporation d. LLC e. LLP
Applicants (Corporations, LLC, LP, LLP, etc) with fillings with the Indiana Secretary of State Business Services are required to submit copies of their
fillings (Articles of Incorporation, etc.) with the application.
14. Do you intend to buy dealer plates?
YesNo
How many?
15. Do you intend to buy interim plates?
YesNo
How many?
16. ZONING APPROVAL - TO BE COMPLETED BY LOCAL ZONING BOARD / AUTHORITY.
I, the undersigned, ver ify complian ce with lo cal zoning ordinance s or other lo cal ordinan ces fo r conducting motor vehicle business at the address cite d above.
Original ink signature Date (month, day, year)
Printed or typed name Title
Authorizing agency
Reset Form
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17. OWNER / OFFICER INFORMATION
A. Name of primary owner
Title
Home address (number and street)
ZIP Code
City
State
Home telephone number
( )
B. Name of additional owner
Title
Home address (number and street)
ZIP Code
City
State
Home telephone number
( )
C. Name of additional owner
Title
Home address (number and street)
ZIP Code
City
State
Home telephone number
( )
The applicant and all corporate officers, partners, and owners must submit to a national criminal history background check (as defined in IC 10-13-3-12)
administered by the state police at the expense of the applicant and the corporate officers, partners, and owners. The secretary may deny an application
based upon felony or misdemeanor convictions related to dealing in motor vehicles.
18. Has any owner, partner, officer, or director of the applicant owned or worked for another dealership in this or any other state?
YesNo
If yes, name of individual
Name of dealership
Address of dealership (number and street)
City
State
ZIP code
If yes, name of individual
Name of dealership
Address of dealership (number and street)
City
State
ZIP code
19. Name of person upon whom legal service or process may be made
Telephone number
( )
Address (number and street, city, state, and ZIP code)
20. If corporation, LLC, or LLP, state of action
Date of action(month, day, year)
If foreign corporation (not Indiana), date of admission to do business in Indiana
(month, day, year)
21. REPRESENTATIVE ADDRESS (number and street)CITY STATE ZIP CODE TELEPHONE NUMBER
22. QUESTIONS
Has any owner, partner, or director on the application ever been arrested or convicted of a crime that has not been expunged by a court?
YesNo
If yes, please give details.
Has any owner, partner, or director on the application had a license suspended, or revoked or had an application for a license denied
in this or any other state?
YesNo
If yes, please explain.
Is this location devoted solely to the business of buying, selling, and/or exchanging motor vehicles?
YesNo
If no, please explain.
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PLEASE NOTE:Every dealer, manufa cturer, or distr ibutor must file wit h the Secretary of State a current copy of each fran chise to which it is a party;
or, if multiplefranchises are identical except for stated items, a copy of the fran chise form with su pplemental schedules of variations
from the form is acceptable.
A Surety Bond is required for all dealers licen sed under IC 9-32-11.
All application s must have the applicat ion I lice nse fee atta ched. Fees are posted on the Secre tary of State , Auto Dealer Service
Divisionwebsite:www.in.gov/sos/dealer
.
All books, records, and files relating to the applicant’s inventory and motor veh icle title s must be kept at the established place of
business and be available for inspection.
I hereby certify , under the pena lty o f perjury , that I am author ized to make t his applicat ion and that the answers and information con tained in this applica tion are
true and correct.
Original ink signature of applicant Date (month, day, year)
Printed or typed name
Title
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