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Reset Form CONNIE LAWSON SECRETARY OF STATE DEALER DIVISION 302 W. Washington Street Room E018 Indianapolis Indiana 46204-2700 Telephone 317 234-7190 Fax 317 233-1915 www. The Surety shall not be discharged from any liability already accrued under the bond or which shall accrue hereunder before the expiration of the thirty 30 day notice period. Sos. in.gov INDIANA VEHICLE MERCHANDISING CERTIFICATE / BOND State Form 53966 R5 / 6-15 Pursuant to IC 9-32-11-2 Dealer number Start / Issue date month day year Expiration date month day year Bond amount Name of Principal Address of Principal number and street city state and ZIP code Name of Surety Address of Surety number and street city state and ZIP code Certificate / Bond number This Certificate / Bond is applicable to the following type of License please check the appropriate box Automobile Auctioneer Manufacturer Converter Manufacturer Transfer Dealer Dealer Wholesale Dealer Automotive Salvage Recycler Auto Mobility Dealer Distributor Watercraft Dealer The Principal and Surety noted above are held and firmly bound unto the State of Indiana - Secretary of State in the amount noted above jointly and severally. This bond is conditioned on the Principal s compliance with all provisions of the laws ordinances and resolutions governing issuance of the license issued by the Secretary of State. This bond is in favor of the Secretary of State for fines penalties costs and fees assessed by the Secretary of State after notice opportunity for a hearing and opportunity for judicial review and for securing the payment of damages to a person aggrieved by a violation of IC 9-32 by the principal after a judgment is issued in favor of the aggrieved person. This bond begins and ends on the start date and expiration date noted above or as otherwise described herein. The Surety may terminate its liability hereunder at any time by giving thirty 30 days notice of such termination to the Secretary of State at 302 West Washington Street Room E018 Indianapolis IN 46204. The total aggregate liability of the surety shall not exceed the penal sum of the bond. The Surety reserves the right to modify the terms of this Bond. This bond is in favor of the Secretary of State for fines penalties costs and fees assessed by the Secretary of State after notice opportunity for a hearing and opportunity for judicial review and for securing the payment of damages to a person aggrieved by a violation of IC 9-32 by the principal after a judgment is issued in favor of the aggrieved person. This bond begins and ends on the start date and expiration date noted above or as otherwise described herein. The Surety may terminate its liability hereunder at any time by giving thirty 30 days notice of such termination to the Secretary of State at 302 West Washington Street Room E018 Indianapolis IN 46204. Cancellation of this bond is also effective immediately upon termination of the Principal s Dealer License. Name of authorized agent Title of Principal s owner / agent Signature of Surety Signature of Principal s owner / agent Telephone number of Surety E-mail address of Surety. Any modification must be conveyed in writing to the Principal and the Secretary of State ten 10 days prior to any changes taking effect.

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