Indiana Code Title 3. Elections § 3-7-31-5

(1) provide for the residence address and the mailing address of the individual completing the forms;

(2) contain a statement that a notice of disposition of the person's registration application will be mailed to the mailing address of the individual;

(3) require the applicant to provide the applicant's voter identification number;

(4) require an individual subject to IC 3-7-32-8 who receives a completed application from the applicant to state on the application the name and residence address of the individual and the date on which the individual received the application from the applicant, with this statement being certified to by the individual under the penalties for perjury;  

(5) contain a receipt to be given by an individual subject to IC 3-7-32-8 to the applicant when the individual receives the completed application;  and

(6) if the form is a mail registration form: