Free 45702.FH11 - Indiana

APPLICATION FOR DEALER VEHICLE IDENTIFICATION INSPECTION
State Form 45702 (R3 / 5-08)

Reset Form

SECRETARY OF STATE - DEALER DIVISION 6400 East 30th Street Indianapolis, Indiana 46219 Telephone: (317) 591-5303 Fax: (317) 591-5319

* This agency is requesting disclosure of your Social Security Number in accordance with IC 4-1-8-1; disclosure is mandatory and this record cannot be processed without it.

Dealers who have been in business for five (5) years and have sold at least 150 vehicles in the previous calendar year may submit an application designating up to two (2) employees to perform vehicle identification number (VIN) inspections (IC 9-17-2-12). Regardless of submission date, all appointments expire on December 31 of each calendar year. These inspections can only be performed on vehicles in your inventory. By law, no fee is to be charged to your customers to perform these inspections. Any vehicle with an altered VIN plate or without a public VIN (VIN plate on dashboard) must be inspected by a police officer. Document the inspection either on State Form 44049, Application for Certificate of Title, or State Form 39530, Affidavit of Police Officer. For further information, please contact the Secretary of State, Dealer Division, at the above address. To delete VIN inspectors you must contact or fax the Secretary of State, Dealer Division, at the above address. To add or replace a VIN inspector, mail or fax this form to the above address.
I. DEALERSHIP INFORMATION
Name of dealership Dealer number Address (number and street, city, state, and ZIP code) Telephone number Fax number Registered retail merchant certificate number

(

)

(

)

E-mail address

II. DESIGNATED EMPLOYEES
Name of employee one Address (number and street, city, state, and ZIP code) Drivers license number Name of employee two Address (number and street, city, state, and ZIP code) Drivers license number State Social Security Number * State Social Security Number *

I, the undersigned, swear or affirm that the information I have entered on this form is correct and that I will discharge my duties as vehicle identification number (VIN) inspector faithfully and in accordance with Indiana law. I understand that making a false statement on this form may constitute the crime of perjury.
Signature of employee one Signature of employee two Date (month, day, year) Date (month, day, year)

SOS USE ONLY Authority is hereby granted for above name employee(s) to perform VIN inspections for your dealership. This inspection authority expires annually on December 31.
Signature Printed name Date (month, day, year)