Ad 19 Form PDF Details

The Ad 19 Form is an affidavit required by the Indiana Department of Revenue for domestic corporations seeking reinstatement of their active status. Any domestic corporation that has lost its active standing in Indiana must complete and submit this affidavit before the Indiana Secretary of State can restore its legal status.

The document requires the corporation's full legal name, the official capacity of the person signing, the date of original incorporation, the principal office address, and both Federal and Indiana tax identification numbers. The signing officer must affirm that all Indiana taxable income received since May 1, 1933 has been included in state income tax returns and that all taxes due have been paid in full.

Corporations may lose active status for reasons such as failure to file annual reports, failure to pay state fees, or noncompliance with Indiana tax obligations. Once a corporation loses its good standing, it cannot legally conduct business in the state, enter into contracts, or initiate legal actions until reinstatement is approved. Restoring active status requires demonstrating to the Indiana Department of Revenue that the corporation is fully compliant with state tax law.

After submitting the affidavit, the Indiana Department of Revenue reviews the filing to verify tax compliance. If the review is successful, the Indiana Secretary of State restores the corporation to active status. Completing this document accurately is critical, as incomplete or incorrect submissions can result in delays or rejection of the reinstatement application.

QuestionAnswer
Form NameAd 19 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesAd 19 Indiana, reinstatement affidavit, Indiana Department of Revenue AD-19

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AD-19

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.

How to Edit Ad 19 Form Online for Free

Before you begin completing this affidavit, gather the following information and documents. Having everything ready in advance reduces the risk of errors and speeds up the submission process considerably.

  • The full legal name of the corporation as registered with the Indiana Secretary of State.
  • The official title of the officer who will sign (President, Vice President, Secretary, or Treasurer).
  • The original incorporation date as recorded by the Indiana Secretary of State.
  • The current principal office address of the corporation.
  • The corporation's Federal Employer Identification Number (FEIN) from the IRS.
  • The Indiana sales tax or withholding Tax Identification Number (TID).
  • Confirmation from the Indiana Department of Revenue that all state tax returns are filed and taxes are paid in full.
  • A notary public available to witness the signature at the time of signing.

How to Fill Out the Ad 19 Form

To fill out this affidavit, enter the corporation's official name and officer details, provide both tax identification numbers, and affirm that all Indiana taxable income has been reported and all taxes paid. Each section must be completed accurately, as errors or omissions can delay or prevent reinstatement.

  1. Corporation name. Enter the full legal name of your domestic corporation exactly as it appears in Indiana state records. Use the official registered name and avoid abbreviations or informal versions. An incorrect name is one of the most common causes of rejection.
  2. Officer identity and capacity. Provide the full name and official title of the authorized officer completing the affidavit. Accepted titles include President, Vice President, Secretary, or Treasurer. The person signing must have legal authority to act on behalf of the corporation.
  3. Incorporation date. Record the exact date the corporation was originally incorporated in the State of Indiana. This date should match the record on file with the Indiana Secretary of State.
  4. Principal office address. List the full current address of the corporation's principal place of business, including street, city, state, and ZIP code.
  5. Federal Employer Identification Number (FEIN). Enter the nine-digit Federal ID number assigned to the corporation by the IRS. Do not substitute the state tax ID number in this field.
  6. Indiana tax identification number (TID). Provide the Indiana sales tax or withholding TID number issued by the state. Both the FEIN and TID are required to verify tax compliance status.
  7. Tax compliance affirmation. By signing, the officer confirms that all Indiana taxable income received since May 1, 1933 has been included in state income tax returns and that all taxes owed have been paid. This sworn declaration is the central requirement of the affidavit and must be truthful and accurate.
  8. Sign before a notary. The authorized officer must sign the completed form in the presence of a notary public. A form signed without notarization is not legally valid and will be rejected by the Indiana Department of Revenue.

After submitting this affidavit to the Indiana Department of Revenue, the information is reviewed to confirm the corporation meets all tax compliance requirements. For other Indiana business documents, see the Indiana LLC Operating Agreement or the Indiana Small Estate Affidavit.

What Are Common Mistakes When Filing This Reinstatement Affidavit?

Corporations sometimes face delays or rejections because of avoidable errors. The most common mistakes are using an abbreviated corporation name, failing to notarize the form, and submitting before all outstanding state tax filings are current. Taking time to review each section before submitting reduces the likelihood of rejection.

  • Using an informal or abbreviated name instead of the full legal corporation name as it appears in state records.
  • Failing to have the form signed and notarized before submission. An unnotarized affidavit is not legally valid.
  • Leaving the Federal or Indiana tax identification number blank or entering an incorrect value. Both numbers are required.
  • Submitting the document before ensuring all outstanding tax returns are filed and all taxes paid in full.
  • Using an outdated version of the form. Always confirm you are using the current version from the Indiana Department of Revenue before submission.

Frequently Asked Questions About This Affidavit

These answers address the most common questions about the Indiana corporate reinstatement affidavit, based on Indiana Department of Revenue and Secretary of State requirements.

Who needs to file this reinstatement affidavit? Any domestic corporation that has lost its active status in Indiana must submit this document before the Indiana Secretary of State can reinstate it. This includes corporations that lost good standing because of missed annual reports, unpaid state fees, or outstanding tax obligations. The corporation cannot legally conduct business in Indiana until its active status is restored through the reinstatement process.

Where do you submit the affidavit? Submit the completed and notarized document to the Indiana Department of Revenue. The Department reviews it to confirm the corporation has met all tax compliance requirements. After a successful review, it forwards approval to the Indiana Secretary of State, who then processes the final reinstatement of the corporation's active status.

Does the form need to be notarized? Yes. The authorized officer must sign the affidavit in the presence of a notary public. The notarized signature is required for the document to be legally valid. Any submission that lacks notarization will be rejected without review. Plan to have a notary available at the time of signing to avoid unnecessary delays.

How long does the reinstatement process take? Processing times vary based on submission volume and the complexity of the corporation's tax history. Filings that are complete and accurate are typically resolved more quickly than those with outstanding issues. Corporations that have unresolved tax liabilities may need to address those separately before the reinstatement can move forward. Once the Department approves the filing, it notifies the Indiana Secretary of State to restore the corporation's active status. Processing typically takes several weeks for complete filings with no outstanding liabilities. Contact the Indiana Department of Revenue directly for current processing timelines and any additional requirements.

For related Indiana state documents, see the Indiana Form 130 for state tax filings or the Indiana Contempt of Court form for court proceedings.