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Indiana Department of Revenue Proportional Use Credit Certification Application Fee 7. 00 PROP-1 Rev. 08/00 Complete this Section only if different than lines 1 3 5 6 7.

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U.S. Post Office Box 18. Applicant Signature 19. Signature of Respondent 20. Certification of Financial Responsibility. (A) I have reviewed the application. There is nothing in this application that is incomplete, inaccurate or inconsistent with the foregoing information. (B) The applicant is the legal owner of all the following: (1) Business and/or residential use of this property has an annual gross income in excess of 30,000.00 and the business or residences on the property are more than 10,000 square feet in size or have more than 20 people in the business or residences on the property. (2) For business and/or residential use of this property, the applicant has a paid-up property tax liability of less than 100.00. (3) For business and/or residential use of this property, the applicant has not filed the correct or complete Statement of Information or the Indiana Secretary of State has not notified the applicant of a change in information pertaining to the applicant in this information report. In addition, the applicant has not provided the Secretary of State the following information: (A) A complete and accurate Social Security Number. (B) Valid, current, proof of insurance. (4) The applicant will establish that the applicant's income is sufficient to satisfy the minimum income requirements set by the Secretary of State. (5) The applicant's liability (if any) for any taxes set forth in sections 1 – 11(b) of section 11-19 of the Income Tax Law or any portion thereof may not exceed the minimum liability established by section 11-19 of the Income Tax Law in effect as of the commencement date of such income and will not include any tax on which the applicant may be assessed. (6) The applicant maintains a sufficient number of licensed business or residential property tax rates in effect in Indiana to satisfy the minimum liability established by section 11-19 of the Income Tax Law in effect as of the commencement date of such income. (7) The applicant's income cannot be determined by any information provided by, or on file with, the Secretary of State, except that, for a business using a business entity as an address, the applicant need only list the business entity if that entity is a real or personal property owner.

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