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Governor Mike Braun
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Applicant Information

2-1-1 Name and Address
2-1-2 Daytime Telephone Number
2-1-3 FAX Number - If Available
2-1-4 Example Applicant Information

2-1-1 Name and Address

A. Provide the name and complete mailing address of the applicant.

  1. If there are multiple applicants, provide the name and address of the applicant serving as the contact person on the application form and the names and addresses of the additional applicants on a separate page.
  2. If the applicant is a governmental unit or a business interest, provide the unit's or business' name and address and the name of a contact person on the application form.

B. If the applicant(s) own the property on which the project will be or has been constructed, the name(s) should be provided as they appear on the property deed or title.

C. If the applicant(s) do not own the property on which the project will be or has been constructed, provide the name(s) of the property owner(s) in the "Property Owner Information" section of the application form.

2-1-2 Daytime Telephone Number:

A. Provide the applicant's or contact person's daytime telephone number. Include the area code and applicable extension.

2-1-3 FAX Number - If Available:

A. Provide the applicant's or contact person's FAX number. Include the area code and applicable extension.

2-1-4 Example Applicant Information:

A. Single Applicant - Applicant shown on the application form

  1. Application Form Mr. John R. Anderson
    165 South Beechwood Drive
    Greenwood, Indiana 46142

    Phone 317-555-1212

B. Multiple Applicants - Applicants shown on the application form

  1. Application Form Mr. and Mrs. Paul E. Stevens
    8973 Lake View Terrace
    Wolcottville, Indiana 46795

    Phone 219-555-1212

C. Multiple Applicants - Contact person shown on the application form with the additional applicants shown on a separate page

  1. Application Form Mr. Michael A. Smith (contact person)
    R.R. 1, Box 359
    Petersburg, Indiana 47567

    Phone 812-555-1212
    FAX 812-555-1212
  2. Separate Page
    Additional Applicants
    Mr. and Mrs. James R. Gamble
    R.R. 1, Box 365
    Petersburg, Indiana 47567

    812-555-1212, 812-555-1212    		Mr. Herbert J. Small
    R.R. 1, Box 393
    Petersburg, Indiana 47567

    812-555-1212
    Mr. Paul J. Fisher
    R.R. 1, Box 378
    Petersburg, Indiana 47567

    812-555-1212    		Mr. and Mrs. Robert L. Miles
    R.R.1, Box 398
    Petersburg, Indiana 47567

    812-555-1212
    Mr. Richard M. Minnett
    R.R. 1, Box 387
    Petersburg, Indiana 47567

    812-555-1212    		Mrs. George K. Wilson
    R.R. 1, Box 399
    Petersburg, Indiana 47567

    812-555-1212
    Mr. and Mrs. David R. Probst
    R.R. 1, Box 389
    Petersburg, Indiana 47567

    812-555-1212    		Mrs. Lucille M. Morehouse
    R.R. 1, Box 401
    Petersburg, Indiana 47567

    812-555-1212
    Mr. and Mrs. Timothy J. Stirn
    R.R. 1, Box 391
    Petersburg, Indiana 47567

    812-555-1212    		 

D. Governmental Unit - Entity name and contact person shown on the application form

  1. Application Form Hamilton County Board of Commissioners
    Mr. James R. Holloway, County Engineer
    Room 25, Court House Annex
    Noblesville, Indiana 46060

    Phone 317-555-1212 extension 531
    FAX 317-555-1212

E. Business Interest - Business name and contact person shown on the application form

  1. Application Form L & K Industries, Inc.
    Ms. Debra A. Jones, Plant Manager
    Room 7-A, Building 3
    3549 Commerce Drive
    West Lafayette, Indiana 47906

    Phone 317-555-1212 extension 390
    FAX 317-555-1212 extension 475