Indiana Tax Clearance Form Instructions

Obtaining or renewing a liquor license in Indiana involves more than just filling out an application with the Alcohol and Tobacco Commission (ATC); it requires proving that your business is in good standing with the state tax authorities. The Indiana Tax Clearance Form (State Form 53227) is the critical document used to bridge the gap between the Department of Revenue (DOR) and the ATC. Its primary purpose is to verify that an applicant has no outstanding tax warrants or liabilities before a permit can be issued, renewed, or transferred. Under Indiana Code, the commission is legally prohibited from granting permits to any entity appearing on the most recent tax warrant list. Therefore, this form serves as a mandatory “check-up,” authorizing the DOR to release your tax status information directly to the ATC. Whether you are a wholesaler, retailer, or dealer, failing to submit this form—or submitting it with errors—can result in significant delays or the outright denial of your permit application. It acts as a green light, signaling that your financial house is in order and you are cleared to proceed with your business operations.

How To File The Tax Clearance Form

Filing this form is a targeted process designed to get your information to the right division within the Department of Revenue. You have two primary options for submission:

Mail: You can send the completed original form to the Titles & Clearances Division at 100 N. Senate Ave, Indianapolis, IN 46204.
In-Person: If you prefer hand-delivery, you can bring the form to Room N-105 at the Indiana Government Center North in Indianapolis.

Important Note: The form states that the “original blue form” must be completed, signed, and returned. Once processed, the clearance is valid for only thirty days, so time your submission carefully to align with your hearing or application dates.

How to Complete Indiana Tax Clearance Form

Header Section: Permit Details

At the very top of the document, you will find spaces for administrative details regarding your permit.

Permit Number: Enter the specific license or permit number assigned to your business by the Alcohol and Tobacco Commission.
Hearing Date: If you have a scheduled hearing with the local alcoholic beverage board, write that date here.
Expiration Date: List the date your current permit expires (if applicable for renewals).

Section 1: Tax Identification Numbers

This section links your business to its tax records.

Federal ID Number (FID): Enter your Federal Employer Identification Number (FEIN).
State Tax ID Number (TID): Enter your 10-digit or 13-digit Indiana Taxpayer Identification Number.

Section 2: Corporate, Partnership, or Sole Proprietor Information

Here, you provide the legal contact details for the business entity.

Name: Print the full legal name of the corporation, partnership, or sole proprietor.
Phone Number: Provide a reliable contact number for the business.
Mailing or Street Address: Enter the primary mailing address for the legal entity.
City, State, ZIP Code: Fill in the city, state, and postal code associated with the address above.
County: Write the name of the county where the legal entity is based.

Section 3: Business Trade Name (DBA)

If your business operates under a name different from its legal name, fill out this section.

Name: Enter the “Doing Business As” (DBA) name or the trade name known to the public.
Phone Number: Enter the phone number for the specific business location.
Location Address: Provide the physical street address where the business actually operates (not a P.O. Box).
City, State, ZIP Code: Enter the city, state, and ZIP code for the physical location.
County: List the county where this specific business location is physically situated.

Section 4: Nonprofit Information

This section determines if special tax statuses apply.

Is this business registered as a nonprofit organization in Indiana?: Check the box for “Yes” or “No”.
If yes, what is your number?: If you checked “Yes,” enter your nonprofit registration or exemption number on the line provided.

Section 5: Type of Ownership

Identify the legal structure of your business by checking the appropriate box.

Sole Proprietorship: Check if you are an individual owner.
Partnership: Check if two or more people own the business.
Corporation (For Profit): Check if you are a standard corporation.
Government: Check if the entity is a government body.
Other (Specify): If your structure is an LLC or another type not listed, check this box and write the specific type on the line provided.

Section 6: Incorporation Details

This section is primarily for corporations, but other entities may need to provide dates.

State of Incorporation: Enter the state where your corporation was legally formed.
Date of Incorporation: Write the exact date the corporation was established.
State of Corporate Domicile: Enter the state that is considered the legal home of the corporation.
If not a corporation, enter date authorized to do business in Indiana: For partnerships, LLCs, or sole proprietors, enter the date you officially started or registered to do business in the state.
Accounting Period Year Ending Date (mm dd): Enter the month and day your fiscal tax year ends (e.g., 12 31 for December 31st).

Section 7: Bankruptcy Information

Has this business entity ever filed bankruptcy?: Check “Yes” or “No”.
If so, when?: If you checked “Yes,” write the date the bankruptcy was filed.

Authorization And Signature

This final step is legally binding and grants permission for the tax check.

Authorization Statement: By signing, you authorize the Department of Revenue to share your tax status with the Alcohol and Tobacco Commission.
Authorized Signature: The owner, officer, or authorized agent must sign here.
Title: Print the job title of the person signing (e.g., Owner, President, Manager).
Date: Enter the date you signed the form.

Note: The bottom portion labeled “Department Use Only” should be left blank. This area is for official use by state employees to mark the status of your accounts (A/R, WTH, CIT, etc.).