Free 43724.FH11 - Indiana

APPLICATION FOR WATERCRAFT DEALER PLATES / REGISTRATIONS
State Form 43724 (R3 / 5-08)

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Send completed application to:

Secretary of State - Dealer Division 6400 East 30th Street Indianapolis, IN 46219 Telephone: (317) 591-5304

Legal name of business

Address (number and street)

City, state, and ZIP code

Dealer number

Telephone number

(

)

Item(s) requested (check all that apply)

Sets of plates (One registration will accompany 2 dealer plates.)
Number of sets of plates requested

Duplicate Registration (no plates)

Duplicate Plate(s)

Registration number

Plate(s) number(s)

I hereby certify, under the penalty of perjury, that the answers and information contained in the application are true and correct.
Signature of owner, partner or officer Date signed (month, day, year)

Typed or printed name and title of owner, partner, or officer