Free 23350.pdf - Indiana

APPLICATION FOR DEALER PLATES
State Form 23350 (R6 / 1-98) Approved by State Board of Accounts, 1998 Date received (month, day, year)

BUREAU OF MOTOR VEHICLES Dealer Section 6400 E. 30th Street Indianapolis, IN 46219 Dealer number

INSTRUCTIONS: DO NOT WRITE IN SHADED AREAS.
Name of business Telephone number Indicate type of plates being applied for by checking only one box. A Dealer - New F Recreational Vehicle Dealer Address (street and number) B Manufacturer G Wholesale Dealer C Dealer - Used H Transfer Dealer City State ZIP code D Mobile Home Dealer I Motorcycle Dealer - New E Trailer Dealer J Motorcycle Dealer - Used INVOICE - Add Fee and Mailing Charge (if applicable) for Total Fee CHECK I hereby certify, under penalty of perjury, that the anONE PLATES AND FEES TOTAL swers and information contained in this application are true and correct. Fee Set of two (2) Dealer plates @ $45.25 Signature of owner, partner or officer $ Set of two (2) Motorcycle Dealer plates @ 20.25 Will Pick Up Please mail (if so, Mailing Charge $3.00)

Application must be accompanied by check or money order.

TOTAL FEES

Dealer No.

Typed or printed name and title

$

APPLICATION FOR DEALER PLATES
State Form 23350 (R6 / 1-98 Approved by State Board of Accounts, 1998 Date received (month, day, year)

BUREAU OF MOTOR VEHICLES Dealer Section 6400 E. 30th Street Indianapolis, IN 46219 Dealer number

INSTRUCTIONS: DO NOT WRITE IN SHADED AREAS.
Name of business Telephone number Indicate type of plates being applied for by checking only one box. A Dealer - New F Recreational Vehicle Dealer Address (street and number) B Manufacturer G Wholesale Dealer C Dealer - Used H Transfer Dealer City State ZIP code D Mobile Home Dealer I Motorcycle Dealer - New E Trailer Dealer J Motorcycle Dealer - Used INVOICE - Add Fee and Mailing Charge (if applicable) for Total Fee CHECK I hereby certify, under penalty of perjury, that the anONE PLATES AND FEES TOTAL swers and information contained in this application are true and correct. Fee Set of two (2) Dealer plates @ $45.25 Signature of owner, partner or officer $ Set of two (2) Motorcycle Dealer plates @ 20.25 Will Pick Up Please mail (if so, Mailing Charge $3.00)

Application must be accompanied by check or money order.

TOTAL FEES

Dealer No.

Typed or printed name and title

$

APPLICATION FOR DEALER PLATES
State Form 23350 (R6 / 1-98) Approved by State Board of Accounts, 1998 Date received (month, day, year)

BUREAU OF MOTOR VEHICLES Dealer Section 6400 E. 30th Street Indianapolis, IN 46219 Dealer number

INSTRUCTIONS: DO NOT WRITE IN SHADED AREAS.
Name of business Telephone number Indicate type of plates being applied for by checking only one box. A Dealer - New F Recreational Vehicle Dealer Address (street and number) B Manufacturer G Wholesale Dealer C Dealer - Used H Transfer Dealer City State ZIP code D Mobile Home Dealer I Motorcycle Dealer - New E Trailer Dealer J Motorcycle Dealer - Used INVOICE - Add Fee and Mailing Charge (if applicable) for Total Fee CHECK I hereby certify, under penalty of perjury, that the anONE PLATES AND FEES TOTAL swers and information contained in this application are true and correct. Fee Set of two (2) Dealer plates @ $45.25 Signature of owner, partner or officer $ Set of two (2) Motorcycle Dealer plates @ 20.25 Will Pick Up Please mail (if so, Mailing Charge $3.00)

Application must be accompanied by check or money order.

TOTAL FEES

Dealer No.

Typed or printed name and title

$