Free 48911.FH11 - Indiana

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APPLICATION FOR AUCTIONEER LICENSE ACTIVATION
State Form 48911 (R2 / 5-08)

INDIANA AUCTIONEER COMMISSION PROFESSIONAL LICENSING AGENCY 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 Telephone: (317) 234-3040 E-mail: [email protected] www.pla.IN.gov

* Your Social Security number is being requested by this state agency in accordance with IC 4-1-8-1. Disclosure is mandatory and this record cannot be processed without it.

PLEASE NOTE:

In order to reactivate an inactive license during a four (4) year license period, the licensee must obtain sixteen (16) hours of continuing education required by IC 25-6.1-9-1. 1. Complete the application. 2. Attach proof of sixteen (16) hours of continuing education. 3. Send to the above address. APPLICANT INFORMATION
Social Security number *

INSTRUCTIONS:

Name of applicant (last, first, middle)

Residential address (number and street, city, state and ZIP code)

Telephone number

E-mail address

License number

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Date (month, day, year)

Signature of applicant