Fillable Form 1: PROPERTY TAX CLEARANCE SCHEDULE - FORM

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Form 1: PROPERTY TAX CLEARANCE SCHEDULE - FORM

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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, 201
1
INDIANA ALCOHOL AND TOBACCO COMMISSION
Name of individual' or company
If transfer, give former
name of business
Mailing Address (
street and number of rural route)
Renewal
Transfer (Check all that apply)
City State ZIP Code
Ownership
Location
Doing business as (DBA)
Stock
Permit location (street address)
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, 201
1
INDIANA ALCOHOL AND TOBACCO COMMISSION
Name of Individual or company
If transfer, give former name of business
New
Mailing Address (street and number of rural route)
Renewal
Transfer (Check all that apply)
City State ZIP Code
Ownership
Location
Doing business as (DBA)
Stock
Permit location (street address)
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)
STATUS
Permit escrow
DBA change
TYPE
(Check all that apply)
STATUS
Permit escrow
DBA change
TYPE
(Check all that apply)
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Form 1: PROPERTY TAX CLEARANCE SCHEDULE - FORM

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Completed 9 May 2022

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