The Ad 19 form serves as a crucial affidavit for corporations in Indiana seeking reinstatement after losing their active status. Created by the Indiana Department of Revenue, this document requires detailed information about the corporation including the name, the official capacity of the person swearing the affidavit, incorporation date, principal office location, and identification numbers such as the Federal ID and Indiana sales and/or withholding tax TID numbers. Beyond these specifications, the affidavit demands an assertion that the corporation has included all of its Indiana taxable income received since May 1, 1933, in its state income tax returns and that all taxes due have been paid. This submission is essential for corporations aiming to convince the Indiana Department of Revenue of their compliance with state tax obligations, thereby facilitating the process of reinstatement to active status by the Indiana Secretary of State. Ensuring accuracy and completeness in this affidavit can pave the way for a smooth reinstatement process, highlighting the importance of understanding and properly executing the Ad 19 form.
| Question | Answer |
|---|---|
| Form Name | Ad 19 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ad 19 indiana, taxable, TID, incorporation |
Indiana Department of Revenue |
|
Rev. 7/99 |
Affidavit for Reinstatement of Domestic Corporation |
SF 49514 |
|
State of Indiana |
) |
|
) SS |
County of _____________ |
) |
_________________________________________________ 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 |
) |
|
) SS |
County of _______________ |
) |
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, Compliance Division, Room N203, 100 N. Senate Avenue, Indianapolis, IN 46204.