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REGISTRATION OF AUCTIONEER DOING BUSINESS AS (DBA)
State Form 43962 (R3 / 5-08)
PROFESSIONAL LICENSING AGENCY Indiana Government Center South 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 Telephone: (317) 234-3040 Email: [email protected]
Date (month, day, year)
NO FEE
REGISTRATION INFORMATION In compliance with IC 25-6.1-3-3 (a) and (f) or IC 25-6. 1-3-4 (a) and (f), Auctioneer and Auctioning Licensing act, I hereby notify the Indiana Auctioneer Commission that I will on this (date) __________________________ , operate in addition to my original license granted by the Commission an Auction House or Auction Company as follows:
Name of trade or business Address (number and street, city, state, and ZIP code)
Auction House
Auction Company
I hereby certify that I am operating said auction house or auction company as an individual and that I am the sole owner. I also understand that at such time that I shall discontinue or change the address or trade or business name of said auction company or auction house, I shall promptly notify the Commission of such discontinuance or change in writing, pursuant to 812 IAC 1-1-14.
Signature of licensee Printed name of licensee Address (number and street, city, state, and ZIP code) Date (month, day, year) License number