BUSINESS TAX ACCOUNT CHANGE FORM
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.
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.
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.
If the business has a fax number, enter the business fax number.
Enter the business fax number.
Enter the local business tax account number of the business for which the changes are being made.