Form AD-19 at a glance
What it is: Indiana Department of Revenue Affidavit for Reinstatement of Domestic Corporation, made for the purpose of inducing the Department of Revenue to issue a notice which will permit the Secretary of State to reinstate the corporation.
Where and when to file: Mail to: Indiana Department of Revenue, Titles & Clearances Division, P.O. Box 6072, Indianapolis, IN 46206-6072.
You make this affidavit for and on behalf of this corporation, in the official capacity you enter.
A filled-in Form AD-19 example: a corporation president completes the affidavit
How to fill out Form AD-19, box by box
Your name, official capacity and the corporation name
Enter your name, being duly sworn according to law; you affirm under penalty of perjury that you are the official capacity you enter of the corporation name you enter.
The corporation: incorporation date, office address and identification numbers
Enter the incorporation date of the corporation organized under the laws of the State of Indiana.
Enter the address of the principal office with county, city, state and ZIP.
Enter the Federal Employer Identification Number and the Indiana sales and/or withholding tax TID #.
Books and records, and the corporation's business
Enter the address where the books and records of this corporation are kept, in care of a name.
Enter the primary purpose, the business this corporation is engaged in.
Tax paid and the latest return
You affirm under penalty of perjury that, to the best of your belief and knowledge, all of 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.
Enter the month/year the latest Indiana sales and/or withholding tax return was filed for, and the name it was filed under.
Signature, Title and Date
Sign on the Signature line, and fill in Title and Date.
Common questions about Form AD-19
Where do I file it?
Mail to: Indiana Department of Revenue, Titles & Clearances Division, P.O. Box 6072, Indianapolis, IN 46206-6072.
Sources
[1] Form AD-19 State Form 49514 (R7 / 9-20), Affidavit for Reinstatement of Domestic Corporation, Indiana Department of Revenue (the Official source link on this page).