The Indiana AD-19 Form (State Form 49514) is a critical legal document used by administratively dissolved domestic corporations in Indiana to prove they have cleared their tax obligations with the Department of Revenue. When a business is dissolved by the Secretary of State—often due to failure to file annual reports or pay taxes—it cannot legally conduct business until it is “reinstated.” To get reinstated, the corporation must first get a clearance from the Department of Revenue, and that starts with filing the AD-19. This affidavit serves as a sworn statement by a corporate officer declaring that all tax returns (income, sales, and withholding) have been filed and paid in full since the company’s inception or specifically after May 1, 1933. Once the Department of Revenue accepts this affidavit and verifies the tax status, they issue the necessary clearance that allows the business owner to approach the Indiana Secretary of State and officially return their corporation to “active” status.
How To File The AD-19 Form
Filing the AD-19 is a straightforward but formal process because it is a sworn affidavit. You cannot file this online; it must be completed, signed, and physically mailed. After filling out every line as detailed in the instructions below, send the original signed form to the dedicated division at the Department of Revenue.
Mailing Address:
Indiana Department of Revenue
Titles & Clearances Division
P.O. Box 6072
Indianapolis, IN 46206-6072
There is no filing fee mentioned on the form itself for the affidavit, but ensure you check if any outstanding tax payments need to accompany your submission if you know debts exist.
How to Complete Indiana Form AD-19
This form is a continuous narrative paragraph rather than a list of numbered boxes, so you must read carefully to place the right information in each blank space. Below is the breakdown of exactly what to write in each field, in the order they appear on the form.
1. Affiant Name
Line 1: Write the full legal name of the person filling out the form. This person must be an officer or authorized representative of the corporation.
2. Official Capacity And Corporation Name
Line 2 (First Blank): Enter your official title (e.g., President, Secretary, Treasurer).
Line 2 (Second Blank): Write the full legal name of the corporation exactly as it appears on its articles of incorporation.
3. Date Of Incorporation
Line 3: Provide the date the corporation was originally organized under Indiana laws.
4. Principal Office Address
Line 4 (Address): Enter the street address of the corporation’s main office.
Line 4 (County): Write the county where this principal office is located.
Line 5 (City, State, ZIP): Fill in the city, state abbreviation (likely IN), and the ZIP code.
5. Identification Numbers
Line 6: Enter the corporation’s Federal Employer Identification Number (FEIN).
Line 7: Enter the corporation’s Indiana Taxpayer Identification Number (TID) used for sales and/or withholding tax accounts. If you don’t have one, verify if your business type was exempt or if this field should be left blank, but generally, most corporations will have this.
6. Location Of Books And Records
Line 8: Write the physical address where the corporation’s financial books and records are stored.
Line 9: Write the name of the person responsible for keeping these records (e.g., “In care of [Name]”).
7. Nature Of Business
Line 10: Describe the primary business activity or purpose of the corporation (e.g., “Retail Sales,” “Construction Services”).
8. Tax Filing Affirmation
The next section is a sworn statement. By signing, you are affirming that all Indiana taxable income received on and after May 1, 1933, has been reported in filed returns and all taxes have been paid. You do not write anything here; you are agreeing to this statement by signing later.
9. Latest Sales/Withholding Return Details
Line 13 (Month/Year): Enter the month and year of the last sales and/or withholding tax return you filed (e.g., 12/2023).
Line 13 (Name): Write the name under which that last return was filed (usually the corporation name).
10. Signature And Verification
Signature Line: The authorized officer named in Line 1 must sign here.
Title Line: Print the officer’s title again (must match the capacity stated in Line 2).
Date Line: Write the date the form is signed.
Important Note: This affidavit is made “under penalty of perjury.” Ensure every detail, especially regarding paid taxes and filed returns, is accurate before mailing it to the Indianapolis address listed above.