Indiana 711

This Article Explains How To Complete Indiana Form 711 Line By Line So A Purchaser And Seller Can Request Emergency Or Temporary Operating Authority While An Intrastate Certificate Or Permit Is Being Sold And Transferred.

Indiana Form 711, Joint Application For Emergency Or Temporary Authority To Transport Passenger Or Household Goods, is a joint filing used when a motor carrier “purchaser” is in the process of buying and taking over an Indiana intrastate certificate or permit from a seller, and needs temporary authority from the Indiana Department of Revenue (DOR) to operate pending the sale and transfer. In plain terms, it’s the state’s structured way to capture (1) who is buying, (2) who is selling, (3) the entities and owners involved, (4) what operating authority is being transferred or retained, and (5) whether issues like bankruptcy or lack of continuous service could affect the request.The form also signals that DOR will hold a public hearing before issuing intrastate authority, and it tells you what supporting documents must be included (tariffs or rate schedules/contracts, proof of insurance, and Secretary of State documentation for corporations).Because the application is “joint,” both purchaser and seller (and often their representatives) sign, and the signatures are designed to be notarized—so the state can rely on the statements being accurate and sworn.

How To File Indiana Form 711

  1. Complete Every Line on the application. If something doesn’t apply, write “N/A” rather than leaving it blank.
  2. Type Or Write Clearly (typewritten is preferred, but legible is required).
  3. Make A Copy: you must submit the original plus a copy of the finished application.
  4. Attach The Required Supporting Documents (details listed in the “Instructions” section of the PDF), such as tariffs or contracts/rate schedules, proof of insurance, and applicable Secretary of State certificates.
  5. Submit To Motor Carrier Services at the Indiana DOR location shown on the form instructions.
  6. Be Ready For A Hearing: DOR holds a public hearing before issuing a certificate or permit, and hearing details are mailed.
  7. Pay The Fee After Approval: once approved, a $100 filing fee is due, payable to the Indiana Department of Revenue.

Practical Tip: Incomplete passenger/household goods applications are returned, and if DOR finds issues after receipt, they send it back for corrections—then you must resubmit the entire corrected packet.

How To Complete Indiana Form 711 Line-By-Line Instructions

How To Complete Indiana Form 711: Line-By-Line Instructions

Part 1 – Purchaser Information

Line 1. Purchaser’s Name (Include DBA, If Applicable)
Enter the purchaser’s full legal name. If the purchaser uses a “doing business as” name, include it exactly as registered.

Line 2. Street Address
Provide the purchaser’s main mailing street address (no P.O. box unless the form/location accepts it—use the address where official notices can be reliably delivered).

Line 3. City, State, ZIP Code
Fill in the city, state, and ZIP code that match the street address on Line 2.

Line 4. Telephone Number / County / Email Address

  • Telephone Number: give a direct number where someone who understands the application can respond quickly.
  • County: list the county tied to the purchaser’s address.
  • Email Address: add an inbox that is checked regularly for DOR follow-ups.

Line 5. Principal Place Of Business In Indiana (If Different)
If the purchaser’s main Indiana business location is different from the mailing address, complete all fields here:

  • Street Address
  • City, State, ZIP Code
  • County
    If it’s the same as Lines 2–4, write “N/A” or “Same as above,” consistent with the form’s “complete every line” instruction.

Line 6. Type Of Entity (Select One)
Check one entity type for the purchaser:

  • Partnership (and you must list members below)
  • Corporation (and you must list principal officers below)
  • Individual
  • Other (write the entity type, such as LLC, LP, nonprofit, etc.)

Line 7. Partnership Members Or Corporate Principal Officers (Purchaser)
This line has two possible uses—follow the one that matches Line 6

  • If the purchaser is a partnership, list each member’s name and address
  • If the purchaser is a corporation, list each principal officer’s name, title, and address.
    Use the table format provided (Name / Title / Address). If you need more space, attach a separate sheet labeled “Form 711, Part 1, Line 7” and continue the list.

Indiana ID / USDOT Number (To Be Completed By DOR)
Leave this area blank—DOR completes it.

Line 8. State And Date Of Incorporation (If Corporation, LP, Or LLC)
If the purchaser is a corporation, LP, or LLC, complete:

  • State of formation/incorporation
  • Date of incorporation/formation
  • Total number of shares outstanding (as applicable)
  • Most recent year an annual report was filed with the Indiana Secretary of State (enter the year).
    If the purchaser is not one of these entity types, enter “N/A.”

Line 9. Shareholders And Shares Held
List each shareholder’s name and the number of shares held. If there are many shareholders, attach a continuation sheet labeled “Form 711, Part 1, Line 9.”

Line 10. Other Indiana Intrastate Operating Authority Interests
Disclose whether any shareholder listed on Line 9 has a financial interest in other motor carrier companies that already hold Indiana intrastate operating authority, and list:

  • Motor Carrier Company name
  • Indiana intrastate certificate or permit number for that company
    If none, write “None.”

Line 11. Current Indiana Intrastate Operating Authority (If Any)
If the purchaser already holds Indiana intrastate authority, enter:

  • Certificate Number
  • Permit Number
    If the purchaser has neither, enter “N/A.”

Part 2 – Seller Information

Line 1. Seller’s Name (Include DBA, If Applicable)
Enter the seller’s complete legal name, plus any DBA name used for operations.

Line 2. Street Address
Provide the seller’s mailing street address.

Line 3. City, State, ZIP Code
Complete the city, state, and ZIP code for the seller’s street address.

Line 4. Telephone Number / County

  • Telephone Number: provide a reliable contact number for the seller.
  • County: list the county corresponding to the seller’s address.

Line 5. Principal Place Of Business In Indiana (If Different)
If the seller’s primary Indiana business location differs from the mailing address, complete:

  • Street Address
  • City, State, ZIP Code
  • County
    If not different, enter “N/A.”

Line 6. Type Of Entity (Select One)
Check one for the seller:

  • Partnership (members listed below)
  • Corporation (principal officers listed below)
  • Individual
  • Other (specify).

Line 7. Partnership Members Or Corporate Principal Officers (Seller)
As with the purchaser section, complete the table based on entity type:

  • Partnerships: name and address of each member
  • Corporations: name, title, and address of each principal officer
    Attach additional pages if needed and label them clearly.

Line 8. State And Date Of Incorporation (If Corporation)
If the seller is a corporation, fill in:

  • State of incorporation
  • Date of incorporation
  • Most recent year an annual report was filed with the Indiana Secretary of State
    If not a corporation, enter “N/A.”

Line 9. Indiana Intrastate Authority Seller Will Retain (Attach Copies)
List all Indiana intrastate authority certificate/permit numbers the seller is keeping (not transferring). Attach copies as requested. If none are being retained, write “None.”

Line 10. Seller Bankruptcy Status
Check Yes or No for whether the seller is currently in bankruptcy.

  • If Yes, provide the court cause number and the date filed.

Line 11. Prior Bankruptcy History Of Seller Owners/Partners/Shareholders
Answer Yes or No to whether any seller shareholder/partner/owner has previously held that role in a motor carrier that filed bankruptcy.
If Yes, provide the requested details in the table:

  • Name of shareholder/partner/owner
  • Motor carrier name
  • Bankruptcy petition date
  • Cause number
  • Court filed
    Then answer whether that motor carrier held intrastate authority (Yes/No).
    If it did, explain what became of the certificate/permit due to the bankruptcy.

Line 12. Continuous And Adequate Service Under The Authority Being Sold
Check Yes or No to indicate whether the seller has provided continuous and adequate service under the certificate/permit that is pending sale and transfer.

Line 13. Attachment: Certificate/Permit Being Transferred And Scope Of Authority
Attach a copy of the certificate or permit that is being transferred, including the scope of authority DOR granted under it.

WHEREFORE Clause (Request For Temporary Authority)

In the paragraph beginning with “WHEREFORE,” you are asking DOR to grant the purchaser temporary authority while the sale/transfer is pending. Complete each blank carefully:

  • Blank for the type of authority requested (write the exact authority being sought)
  • Blank for what is being transferred (certificate or permit)
  • Blank for the identifying number of that certificate/permit
  • The remaining blanks referencing the authority and the numbered certificate/permit should match what you attach in Line 13.

Signatures, Representative Information, And Notary Areas

Complete every signature line that applies, and do not sign until you are in front of the notary if notarization is required for that signature.

Purchaser Signature Block

  • Signature of Purchaser
  • Printed Name of Purchaser
    If the purchaser is a business, the signer should be an authorized owner/officer/agent.

Purchaser Attorney/Representative Block (If Any)

  • Signature of Attorney or Representative of Purchaser
  • Printed Name of Attorney or Representative
  • Address
  • Telephone Number
  • Email Address

Notary Blocks (Purchaser Side – Two Notary Signature Lines Shown)
The form includes notary signature/printed-name lines and supporting fields:

  • Signature of Notary Public / Printed Name of Notary Public
  • County of Residence
  • Date Commission Expires
    If both notary areas are present on your copy, complete the one(s) required by your execution method; otherwise mark unused ones “N/A” only if appropriate and allowed by the notary process in your situation.

Seller Signature Block

  • Signature of Seller
  • Printed Name of Seller

Seller Attorney/Representative Block (If Any)

  • Signature of Attorney or Representative of Seller
  • Printed Name of Attorney or Representative
  • Address
  • Telephone Number

Notary Jurat Paragraphs (The “STATE OF / COUNTY OF / SS” Sections)
There are two sworn statements formatted for notarization. For each one, fill in:

  • State and County at the top
  • The county and state where the notary is commissioned in the first sentence
  • The name of the person who appeared before the notary (the signer)
  • The day, month, and year where indicated
    The notary then signs/seals according to standard notarial procedure.

Application Instructions (From The Form’s Instruction Page)

Use these requirements as a checklist before you submit:

  • Read the instructions first, and complete the application clearly (typed or legible).
  • Submit the original plus a copy of the completed application.
  • Every line must be completed; if it doesn’t apply, enter “N/A.”
  • Incomplete passenger/household goods applications are returned, and if issues are found after receipt, DOR returns it for correction; after fixing, send back the full corrected package.
  • If you want to visit the walk-in customer service center to set up an account, you must schedule an appointment.
  • DOR will hold a public hearing before issuing a certificate or permit, and hearing details will be mailed; if no protests are filed, the hearing may be summary as described in the cited administrative rule.
  • Include the required supporting items, depending on the authority sought:
    • Two copies of a tariff if applying as a common carrier
    • Two copies of a minimum rate schedule and copies of proposed contracts (or contracts with rates attached) if applying as a contract carrier
    • Proof of insurance meeting the cited Indiana requirements
    • If a non-resident corporation, provide a Secretary of State certificate showing registration to do business in Indiana
    • If an Indiana corporation, provide a Secretary of State certificate of existence.
  • After approval, pay the $100 filing fee (checks payable to the Indiana Department of Revenue).
  • Questions: contact Motor Carrier Services at 317-615-7200 during the listed weekday business hours.
  • Mailing/office location shown: Indiana Department of Revenue, Motor Carrier Services / Insurance and Safety, 7811 Milhouse Road, Suite M, Indianapolis, Indiana 46241-9612.

One Last Detail To Confirm (So I Don’t Miss A Line)

Your uploaded text for Form 711 includes some sentences that appear partially cut off around the “Joint application … authority pending the sale and transfer of …” area in the header region. If you upload a cleaner copy (or an image of that specific section), I’ll revise that paragraph so it’s fully accurate and still paraphrased—without skipping any text.

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