68 IAC 21-9-4 Application by a manufacturer or distributor

Sec. 4. (a) In order to sell or lease licensed supply to a qualified organization, an entity is required to be licensed as a distributor under IC 4-32.3-3-4. A licensed distributor may sell or lease licensed supply to another licensed distributor. In order to manufacture licensed supply for sale or lease to a licensed distributor, an entity is required to be licensed as a manufacturer under IC 4-32.3-3-4. A licensed manufacturer may sell or lease licensed supply to a licensed distributor or another licensed manufacturer. To obtain an annual license, a manufacturer or distributor must submit a written application on a form prescribed by the commission. (b) The manufacturer's application shall include all information deemed appropriate by the commission or the executive director, including, but not limited to, the following: (1) The legal name, doing business as name, if applicable, of the applicant and the address of the applicant's principal place of business. (2) The address of each of the applicant's separate locations where licensed supplies are manufactured. (3) The name and home address of all owners of the applicant's business if it is not a corporation and, if it is a corporation, the name and address of the following: (A) Each officer of the corporation. (B) Each substantial owner. (C) Each key person. (4) The name, business address, and home address of the registered agent for service in Indiana if the applicant is a corporation not domiciled in Indiana. (5) Whether the applicant or a person required to be named in the application is an owner, officer, director, or employee of another entity that would be licensed under this rule. (6) A full description or basic category of the type of licensed supply that will be manufactured. (7) The name of each state where the applicant has been licensed to manufacture, supply, or distribute licensed supplies, the license numbers, the period of time licensed, and whether or not a license has ever been suspended, revoked, or voluntarily forfeited, and the reason for that action. (8) Whether the applicant currently holds a registered retail merchant certificate, out-of-state use tax certificate, or tax advisory letter issued by the department of revenue. If so, the applicant shall provide a copy. (9) A sworn statement signed by the president or owner of the applicant attesting to the truth of the contents of the application. (c) A distributor must purchase licensed supplies to be used in charity gaming in Indiana from a licensed manufacturer or another licensed distributor. The distributor's application shall include the following information: (1) The legal name, doing business as name, if applicable, of the applicant, and the address of the applicant's principal place of business. (2) The name and address of the following: (A) Each location operated by the distributor where licensed supplies are stored. (B) Each owner, if the applicant is not a corporation. (C) Each substantial owner. (D) The registered agent for service in Indiana, if the applicant is a corporation not domiciled in Indiana. (E) Each key person. (3) A full description or the basic category of the type of licensed supply that will be distributed. (4) The name of the states where the applicant has been a licensed distributor, the license number, the period of time licensed, and whether or not a license has ever been suspended or revoked, or voluntarily forfeited, and the reason for that action. (5) The name and address of the manufacturers from which purchases are made to be distributed in Indiana. (6) Whether the applicant currently holds a registered retail merchant certificate, out-of-state use tax certificate, or tax advisory letter issued by the department of revenue. If so, the applicant shall provide a copy. (7) A sworn statement signed by the president or owner of the applicant attesting to the truth of the contents of the application. (d) An entity that both manufactures and distributes licensed supply to be used in charity gaming in Indiana must possess a manufacturer's license and a distributor's license. (e) A license issued to a manufacturer or a distributor is not transferable.