Free 22465.FH11 - Indiana

APPLICATION FOR INTERIM PLATES
State Form 22465 (R6 / 7-08)

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SECRETARY OF STATE - DEALER DIVISION 6400 East 30th Street Indianapolis, Indiana 46219

Type of interim plate

Number of interim plates you are requesting

Vehicle
1. Name of business

Motorcycle

Temporary special permit (watercraft)
Dealer number

2. Address (number and street, city, state, and ZIP code) 3. Current dealer license number 5. Number of sales last calendar year 4. Number of interim plates on hand at the time of this application

Wholesale ____________

Retail ____________

Interim plates are to be issued by Dealers or Manufacturers to buyers of motor vehicles. This plate will authorize the purchaser to operate the vehicle for a period not to exceed (31) days after the date of delivery as indicated upon the interim plate or until regular registration plates have been obtained, whichever event first occurs. The Dealer or Manufacturer who issues the plate must affix the date on which the plate expires to the interim registration plate. The Dealer or Manufacturer must keep a record of interim plate control numbers issued. This record shall include Control Number, Purchaser's Name and Address, Vehicle Year and Make, Identification Number and the Delivery Date. When issuing an interim registration plate, the purchaser should be advised that he/she must carry written evidence of the sale in the vehicle at all times. Dealers are not allowed to transfer interim plates to another dealer.
I hereby certify under penalty of perjury that I am authorized to make this application and that the answers and information contained in this application are true and correct.
Signature of owner, partner or officer Print or type name Title Date (month, day, year)

SOS USE ONLY For ____________ plates issued, beginning Control number _______________________ through ending Control number _______________________