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Form 15 - Auctioneer Filing Status Affidavit (Auctioneer Agent To Individual Auctioneer)

FOR DIVISION USE

ONLY

File No: _____________

Fee No: _____________

Issue Date: __________

County: ____________

Ohio Department of Agriculture

Auctioneers Program/Enforcement Division

8995 E. Main St. Building 1

Reynoldsburg, Ohio 43068

(614) 728-6240

AUCTIONEER FILING STATUS AFFIDAVIT

(Auctioneer Agent to Individual Auctioneer)

Filing Instructions--Read Carefully

1. You must return your current wall license and pocket identification card.

2. A ten thousand dollar ($10,000) auction bond must be filed in your name and listing the

State of Ohio as principal. (Please use Individual Bond Form).

3. There is a $10.00 change of status fee. Make your check or money order payable to the

Treasurer, State of Ohio.

Name: _____________________________________________________________________

Address: ___________________________________________________________________

City/State/Zip: ______________________________________________________________

County of Residence:_________________________________________________________

Day Phone: (

) _____________________

THIS IS TO VERIFY THAT I, _________________________________ acknowledge and

understand that all auction business activities and transactions will be conducted by, through

and for the auctioneer license under which I will be bonded.

______________________________________________

Date: _____________________

Signature of Applicant

Form 15

Form 15 - Auctioneer Filing Status Affidavit (Auctioneer Agent To Individual Auctioneer)