HUSBAND/WIFE OWNERSHIP
BUSINESS TAX ACCOUNT CHANGE FORM
YOU MUST COMPLETE ITEM 1, EITHER ITEM 2 OR ITEM 3 AS APPLICABLE, AND ITEM 4. ENTER INFORMATION IN ITEMS 5 THROUGH 16 IF CHANGES HAVE
OCCURRED. FOR ASSISTANCE, PLEASE CONTACT YOUR LOCAL COUNTY CLERK OR DESIGNATED MUNICIPAL BUSINESS TAX REPRESENTATIVE.
8.
IS BUSINESS LOCATED INSIDE A TENNESSEE CITY LIMITS?
YES
12.
BUSINESS TELEPHONE NUMBER
( )
15a.
(SELECT ONE):
PROPRIETORSHIP
CORPORATION
PARTNERSHIP
OTHER
( )
BUSINESS FAX NUMBER
NO
COUNTY IN WHICH BUSINESS IS LOCATED
(If Yes, Name of City)
LIMITED LIABILITY COMPANY
1.
2.
3.
4.
Effective Date of Changes:
FEIN/SSN:
State Business Tax Account No:
5a.
PREVIOUS ACCOUNT NAME
BUSINESS NAME
STREET, HIGHWAY (DO NOT USE P.O. BOX NUMBER OR RURAL ROUTE NUMBER)
CITY
STATE ZIP CODE
5b.
NEW ACCOUNT NAME
LEGAL NAME, IF DIFFERENT
CITY
STATE
ZIP CODE
7a.
PREVIOUS MAILING ADDRESS
CITY
STATE
ZIP CODE
7b.
NEW MAILING ADDRESS
P.O. BOX, STREET, ROUTE, OR HIGHWAY
CITY
STATE
ZIP CODE
PREVIOUS EXACT LOCATION ADDRESS
NEW EXACT LOCATION ADDRESS
BUSINESS NAME
LEGAL NAME, IF DIFFERENT
6a.
6b.
10a.
10b.
PREVIOUS BUSINESS TAX
CLASSIFICATION
NEW BUSINESS TAX
CLASSIFICATION
9.
BUSINESS E-MAIL ADDRESS
13.
14.
PREVIOUS OWNERSHIP TYPE
17.
THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE
AND BELIEF. (THIS APPLICATION MUST BE SIGNED BY THE INDIVIDUAL OWNER, A PARTNER,
OR AN OFFICER OF THE CORPORATION. THE SIGNATORY MUST ALSO BE LISTED IN ITEM 16.)
SIGN
HERE:
16. IDENTIFY CHANGES IN OWNERS, OFFICERS, PARTNERS, OR CONTACT PERSON
(1) NAME
HOME ADDRESS (DO NOT USE P.O. BOX #)
CITY
HOME TELEPHONE #
STATE ZIP CODE
(2) NAME
HOME ADDRESS (DO NOT USE P.O. BOX #)
CITY
HOME TELEPHONE #
STATE ZIP CODE
RV-F1321101
SIGNATURE of OWNER, PARTNER, or OFFICER (DO NOT PRINT OR USE STAMP)
INTERNET (10-09)
TITLE
DATE
15b.
Member
Owner
Officer Partner
Contact Person
Member
Owner
Officer Partner
Contact Person
SOCIAL SECURITY #
FEDERAL EIN
SOCIAL SECURITY #
FEDERAL EIN
P.O. BOX, STREET, ROUTE, OR HIGHWAY
STREET, HIGHWAY (DO NOT USE P.O. BOX NUMBER OR RURAL ROUTE NUMBER)
NEW OWNERSHIP TYPE
11a.
11b.
IF CLOSING BUSINESS,
INDICATE BELOW
EFFECTIVE DATE OF CLOSURE
CLOSING BUSINESS
Add
Remove
Add
Remove
Local Business Tax Account No:
APARTMENT OR SUITE NUMBER (DO NOT USE P.O. BOX OR RURAL ROUTE NUMBER)
APARTMENT OR SUITE NUMBER (
DO NOT USE P.O. BOX OR RURAL ROUTE NUMBER)
APARTMENT OR SUITE NUMBER (DO NOT USE P.O. BOX OR RURAL ROUTE NUMBER)
APARTMENT OR SUITE NUMBER (
DO NOT USE P.O. BOX OR RURAL ROUTE NUMBER)
FOR OFFICIAL USE ONLY
click to sign
signature
click to edit
INTERNET (10-09)
BUSINESS TAX ACCOUNT CHANGE FORM
INSTRUCTIONS
1.
2.
4.
5.
7.
8.
10.
12.
15.
16.
17.
Enter the date on which the changes you are making to the business tax accout will be effective.
If the business has a Federal Employer Identification Number (FEIN), enter the FEIN. If the business does not have a FEIN, enter
the social security number under which the business is registered.
Enter the state business tax account number of the business for which the changes are being made.
Enter the previous name of the business as recorded on the business tax account in Block 5a. Enter the new name to be recorded
on the account in Block 5b.
Enter the previous mailing address as recorded on the business tax account in Block 7a. Enter the new mailing address to be
recorded for the business in Block 7b.
Enter the name of the county in which the business is located.
Enter the business telephone number.
Select the previous ownership type of the business by checking the appropriate box in Block 15a. Enter the new ownership type
in Block 15b.
Enter the name, home address, home telephone number, FEIN or social security number, as applicable, of owners, officers, or
partners, or contact persons for the business. Check the box that most closely identifies the relationship of the person being named
to the business. Check the appropriate box to indicate if the person is to be added to the account or removed from the account. If
a person is being replaced, enter both the person being added and the person being removed.
This information is critical. It will allow us to identify persons with whom we may discuss the business tax account when needed.
If additional changes are required, please submit them on a separate piece of paper.
The application must be signed by an owner, partner, or officer of the business for which changes are being made. The person who
signs the application must either have been listed in Item 14 on the original business tax application form or be added in Item 16 on
this or other subsequent change forms submitted for the business. Indicate the title of the person signing the application (i.e.,
owner, partner, officer) and the date on which the application is signed.
3
.
6.
Enter the previous location address as recorded on the business tax account in Block 6a. Enter the new location address to be
recorded for the business in Block 6b.
Indicate whether the business is located within the limits of a city in the county. If the business is located within the limits of a city,
enter the name of the city.
Note: A business located within the limits of a city may have a business tax obligation for
both the county and the city. If so, the business must complete a change form for both the county and the city.
9.
11.
Enter the previous business tax classification under which the business filed business tax returns in Block 10a. Enter the new
business tax classification under which the business must file returns in Block 10b.
If the business is closing, check the “Closing Business” box in Block 11a. Enter the effective date of closing in Block 11b.
13.
If the business has a fax number, enter the business fax number.
14.
Enter the business fax number.
Enter the local business tax account number of the business for which the changes are being made.
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