Fillable 22A Nebraska Change of Address Request (TaxFormFinder - One Stop, Every Tax Form)

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22A Nebraska Change of Address Request (TaxFormFinder - One Stop, Every Tax Form)

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Social Security Number
Nebraska ID Number
Nebraska Change of Address Request
for Individual Income Tax Only
FORM
22A
Your First Name and Initial Last Name Your First Name and Initial Last Name
If a Joint Return, Spouse’s First Name and Initial Last Name If a Joint Return, Spouse’s First Name and Initial Last Name
Mailing Address (Number and Street or PO Box) Mailing Address (Number and Street or PO Box)
City, Town, or Post Office State Zip Code City, Town, or Post Office State Zip Code
Previous Name and Mailing Address New Name and Mailing Address
Duly Authorized Signature Date Phone Number
Email Address
sign
here
Under penalties of law, I declare that I have examined this request, and to the best of my knowledge and belief, it is correct and complete.
8-548-1996 Rev. 11-2016
8-548-1996 Rev. 9-2014
You may fax this request to 402-471-5927, or
mail to: Nebraska Department of Revenue, PO Box 98911, Lincoln, NE 68509-8911.
Please keep a copy for your records.
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22A Nebraska Change of Address Request (TaxFormFinder - One Stop, Every Tax Form)

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Completed 20 January 2021

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