State Form 47914 - Application For Registration For An Accounting Professional Corporation
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APPLICATION FOR REGISTRATION FOR
INDIANA PROFESSIONAL LICENSING AGENCY
REAL ESTATE PROFESSIONAL CORPORATION
402 West Washington Street, Room W072
Indianapolis, IN 46204
State Form 47914 (R3 / 10-09)
Telephone: (317) 234-3009
Approved by State Board of Accounts, 2009
Fax: (317) 233-4236
E-mail: pla9@pla.IN.gov
INDIANA REAL ESTATE COMMISSION
Control number
* Your Federal Identification number is requested pursuant to IC 4-1-8-1 and is not mandatory that it be given. Numbers are made
available to the Indiana Department of Revenue.
Federal Identification number *
Date (
)
The proposed Corporation known as _________________________________________________________________________
is engaged in the practice of Real Estate in this state and hereby makes application for registration pursuant to the Professional
Corporation Act of 1983, IC 23-1.5.
The principal office of the Corporation is:
Name
Telephone number
(
)
Address
State of Licensure
Type of License Held
Registration Number
Name and Address
(
)
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