Free 18479.FH11 - Indiana

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APPLICATION FOR EXAMINATION FOR AUCTIONEER LICENSE, LICENSE BY RECIPROCITY, OR TEMPORARY PERMIT
State Form 18479 (R10 / 7-07) Approved by State Board of Accounts, 2007

INDIANA AUCTIONEER COMMISSION PROFESSIONAL LICENSING AGENCY 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 Telephone: (317) 234-3040 E-mail: [email protected]

INSTRUCTIONS: Please type or print legibly.

* Your Social Security number is being requested by this state agency in accordance with
I.C. 4-1-8-1. Disclosure is mandatory, and this record cannot be processed without it. FOR OFFICE USE ONLY APPLICATION FEE DATE FEE PAID (month, day, year) RECEIPT NUMBER LICENSE NUMBER ISSUED DATE LICENSE ISSUED (month, day, year) DO NOT WRITE ABOVE THIS LINE

Type of action requested (please check one only):
Name of applicant

Examination only
APPLICANT INFORMATION

Reciprocal applicant

Temporary permit

Social Security number *

Mailing address (number and street, city, state, and ZIP code)

County

Date of birth (month, day, year)

Resident telephone number

(
Name of business

)

Business address (number and street, city, state, and ZIP code)

County

Business telephone number

Web address

(
Name of Pre-Licensing school

)
Date of graduation (month, day, year)

Broker license number

Salesperson license number

If currently licensed as a real estate salesperson or broker in Indiana, give license number: Has your application for a license as an auctioneer or apprentice auctioneer ever been rejected in this or any other state? If so, explain on a separate sheet where, exact date, and full details of rejection. Has your license as an auctioneer or apprentice auctioneer ever been disciplined in this or any other state? If so, explain on a separate sheet where, exact date and full details of discipline. Have you ever been licensed in this or any other state as an auctioneer or apprentice auctioneer?
If so, where? Issuance date of license (month, day, year)

Yes Yes Yes
License number

No No No

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Have you committed an act which would constitute a ground for disciplinary sanction under IC 25-1.11.5? If so, please explain in an attached sworn affidavit. Have you been convicted of a felony that has a direct bearing on your ability to practice competently? If so, please explain in an attached sworn affidavit. Have you read and do you understand the provisions of The Auctioneer and Auction Licensing Act? Will you display your license in a conspicuous manner in your place of business? Do you understand that an auctioneer license must be kept in your custody and immediately returned by you to the INDIANA AUCTIONEER COMMISSION upon suspension or revocation?
Signature of applicant

Yes Yes Yes Yes Yes
Date (month, day, year)

No No No No No

TEMPORARY PERMIT APPLICATION Pursuant to 812 IAC 1-1-17, applicants for Indiana temporary permits MUST enclose a personally written letter from the owner and/or owners of said property to be sold at auction, requesting and attesting to the necessity of the applicant's services as auctioneer conducting said sale.
Date of auction (month, day, year) Owner of property Location of auction Property to sold

You will automatically be scheduled for the next examination following receipt of your application by the agency. You will be notified by mail at least ten days prior to the exam date.

APPOINTMENT OF INDIANA AUCTIONEER COMMISSION AS AGENT OF AUCTIONEER TO ACCEPT SERVICE OF PROCESS OR PLEADING: I, ___________________________________ of the city of _______________________________ , State of _____________ , do hereby appoint the Indiana Auctioneer Commission as my agent, for the receipt of service of process or pleading in said State of Indiana, upon which Indiana Auctioneer Commission process or pleadings against me may be served. I do hereby consent that suits and actions may be commenced against me in the proper court of any county in the State of Indiana in which the plaintiff may reside by the service of any process or pleadings authorized by the laws of the State of Indiana on the Indiana Auctioneer Commission, and I do hereby stipulate and agree that such service of process or pleadings on the Indiana Auctioneer Commission shall be taken and held in all courts to be as valid and binding upon me as if due service had been made upon me personally within the State of Indiana. The foregoing appointment, consent, stipulation, and agreement shall be deemed to be as is irrevocable. EXAMINATION ONLY Complete section I of this application and pay required fees. Please include a copy of your certificate or course completion with this application. If you have not completed your education, you must provide a copy of your certificate of course completion at the examination site at the time of admittance. Please check here if so: APPLICATION AFFIRMATION I hereby swear or affirm, under the penalties of perjury, that the statements made in this application are true, complete, and correct.
Signature of applicant Date (month, day, year)

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