Form 707 - Joint Application For Sale And Transfer Of Permanent Authority - To Transport Passenger Or Household Goods Page 3

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h. If seller is a corporation, provide the State and the date of incorporation.
________________________________________________________________________________________
(State)
(Date of Incorporation)
Last year annual report was fi led with Indiana Secretary of State: ____________________________________
i.
List all Indiana intrastate authority certifi cate or permit numbers which the seller will be retaining. (Attach Copies)
______________________________________________________________________________________________________________
□
□
j.
Is the seller currently in bankruptcy?
Yes
No
If yes, indicate cause number, date of fi ling and in what court fi led: ____________________________________
________________________________________________________________________________________
k. Has any shareholder, partner or owner of seller ever been a shareholder, partner or owner of a motor carrier
□
□
which has fi led bankruptcy?
Yes
No
If yes, complete the following:
Name of Shareholder,
Motor Carrier
Date of Bankruptcy
Cause Number of
Court Filed In
Partner or Owner
Petition
Bankruptcy Petition
□
□
Did this motor carrier hold Indiana intrastate authority?
Yes
No
If yes, what happened to the certifi -
cate or permit as a result of the bankruptcy? _____________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
l.
Has the seller performed continuous and adequate service under the certifi cate or permit now pending sale and
transfer? _________________________________________________________________________________
In support of this application, the purchaser submits the following exhibits, attached hereto and made part hereof:
Exhibit A
-
A statement describing purchaser’s fi nancial status, including a brief statement of assets and liabilities
as of the date of application, and a copy of applicant’s most recent balance sheet and income statement.
Exhibit B
-
A certifi cate from the Secretary of State of Indiana showing purchaser is registered to do business in
Indiana (if the purchaser is a non-resident corporation); or
A certifi cate of existence from the Secretary of State of Indiana (if the purchaser is an Indiana
(corporation).
Exhibit C
-
A copy of the certifi cate or permit being transferred including the scope of authority granted by the
Department.
Exhibit D
-
If seller is currently in bankruptcy, a copy of the bankruptcy petition.

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