Form 711 - Joint Application For Emergency Or Temporary Authority - To Transport Passenger Or Household Goods Page 5

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Instructions for Joint Application of Emergency Temporary or
Temporary Authority Pending the Sale and Transfer of Certifi cate or Permit
Please read these instructions carefully before completing the application.
The application for emergency temporary or temporary authority pending the sale and transfer of a certifi cate or permit must
be typewritten or legible. The original and one copy of the application must be fi led.
Each line of the application must be completed. If a line is not applicable to you or your company, you should enter “N/A” in
the space provided for the answer.
45 IAC 16-1.5-3 Any person may appear and represent his or her own interest before the commission. The interest of another
person or entity shall be represented only by an attorney authorized to practice before the commission, pursuant to this section.
In order for the application to be processed by the Department, you must include the following with your application:
1. A fi ling fee of $100; make checks payable to the Indiana Department of Revenue;
2. Two copies of a tariff (if you are seeking authority to operate as a common carrier); or
Two copies of a schedule of minimum rates and a copy of each proposed contract, or a copy of the contract, or a
copy of the contract with rates attached (if you are seeking authority to operate as a contract carrier);
3. Proof of insurance as required by IC 8-2.1-22-46 and 45 IAC 16-1-2;
4. A certifi cate from the Secretary of State of Indiana showing that you are registered to do business in Indiana (if
your company is a non-resident corporation); or
A certifi cate of existence from the Secretary of State of Indiana (if your company is an Indiana corporation).
If you have any questions regarding this application, please contact the Department at:
Indiana Department of Revenue
Motor Carrier Services
Insurance and Safety Unit
7811 Milhouse Road, Suite M
Indianapolis, Indiana 46241-9612
or call (317) 615-7295

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