Property Tax Clearance Schedule Double

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PROPERTY TAX CLEARANCE SCHEDULE - FORM NO. 1
Reset Form
ATC permit number
(For a
Person
Business
Corporation)
State Form 1462 (R6 / 7-10)
Expiration date (month, day, year)
Approved by State Board of Accounts, 2011
INDIANA ALCOHOL AND TOBACCO COMMISSION
TYPE
Name of individual' or company
(Check all that apply)
If transfer, give former name of business
New
Renewal
Mailing Address (street and number of rural route)
Transfer (Check all that apply)
Ownership
City
State
ZIP Code
Location
Stock
Doing business as (DBA)
Permit location (street address)
STATUS
Permit escrow
DBA change
City
State
ZIP Code
I, Treasurer of ______________________________________________________ County, hereby certify that the person or company named above has
paid all property taxes in 20____________ (for 20___________ assessment) and property taxes for all prior years, or is exempt from property tax by
reason of __________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
Signature of County Treasurer
Date (month, day, year)
PROPERTY TAX CLEARANCE SCHEDULE - FORM NO. 1
ATC permit number
(For a
Person
Business
Corporation)
State Form 1462 (R6 / 7-10)
Expiration date (month, day, year)
Approved by State Board of Accounts, 2011
INDIANA ALCOHOL AND TOBACCO COMMISSION
Name of Individual or company
TYPE
(Check all that apply)
If transfer, give former name of business
New
Renewal
Mailing Address (street and number of rural route)
Transfer (Check all that apply)
Ownership
City
State
ZIP Code
Location
Stock
Doing business as (DBA)
Permit location (street address)
STATUS
Permit escrow
DBA change
City
State
ZIP Code
I, Treasurer of ______________________________________________________ County, hereby certify that the person or company named above has
paid all property taxes in 20____________ (for 20___________ assessment) and property taxes for all prior years, or is exempt from property tax by
reason of __________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
Signature of County Treasurer
Date (month, day, year)

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