PLEASE SELECT THE FOLLOWING ITEMS TO BE CHANGED:
Business Name Closure of Business Tax Certificate
Business Address
Business Type
Mailing Address
Federal Tax ID/ Social Security #
Telephone / Fax # / E-mail address
FROM TO
BUSINESS NAME: BUSINESS NAME:
BUSINESS ADDRESS:
Street Address:
City:
State:
Zip Code:
BUSINESS ADDRESS:
MAILING ADDRESS: MAILING ADDRESS:
CONTACT INFORMATION:
Telephone #:
Fax #:
E
-Mail:
CONTACT INFORMATION:
Telephone #:
Fax #:
E-Mail:
BUSINESS TYPE: BUSINESS TYPE:
Federal Tax ID #: Federal Tax ID #:
Social Security #: Social Security #:
Closure of Business Tax Certificate (please provide explanation, i.e. business has closed, business is no
longer doing work in the City of Riverside, etc.):
Please note: If your company has a change in ownership, a new business tax certificate may need
to be filed. Please contact the Business Tax office at (951) 826-5465 for further instructions.
3900 Main Street, Riverside, CA 92522 Phone (951) 826-5465 Fax (951) 826-2356
CITY OF RIVERSIDE
BUSINESS TAX CERTIFICATE
MODIFICATION FORM
Street Address:
City:
State:
Zip Code:
Street Address:
City:
State:
Zip Code:
Street Address:
City:
State:
Zip Code:
Business Tax Account Number:
Digital Signature:
Title/Phone:
*There is no fee to submit a modification form. If requesting a replacement copy of the current certificate
or a new certificate reflecting changes, a $12 fee will apply.
Date:
