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Get State Form 40602 (r11 4-09) Approved By State Board Of Accounts, 2009 - In

8 Telephone: (317) 234-3022 E-mail: pla10 pla.IN.gov www.in.gov/pla State Form 40602 (R11 / 4-09) Approved by State Board of Accounts, 2009 INSTRUCTIONS: 1. Please print clearly in ink. 2. All fees are non-refundable and non-transferable. * Your Social Security number is requested by this agency in accordance with IC 4-1-8-1; it is mandatory that it be given. Social Security numbers are made available to the Department of Revenue. FOR OFFICE USE ONLY APPLICATION FEE DATE FEE PAID (month, da.

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