Who Must File. A Form 22 should be led by any taxpayer who:
• Has a name or address change;
• Needs to correct, cancel, reinstate, or change a Nebraska tax certicate, license, or permit; or
• Needs to change the ling frequency for sales and use tax, tire fee, lodging tax, or income tax withholding returns.
One request may be used to correct, cancel, or change more than one certicate, license, or permit held by the taxpayer for the
tax programs listed, provided the Nebraska ID number is the same. Nebraska Change of Address Request for Individual Income
Tax Only, Form 22A, should be used for individual income tax name and address changes.
When and Where to File. Mail to the Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903, or fax
to 402-471-5927, prior to the change.
Permanently Closing the Business. Form 22 should be led to cancel one or more of the tax programs listed in line 5.
You are required to le all tax returns for tax periods through the date of your last transaction, or the last wage payment made
by the date entered on line 6.
Employers who cancel their income tax withholding account should, within 30 days after discontinuing business, le a nal
Nebraska Reconciliation of Income Tax Withheld, Form W-3N, and attach the state copy of each Wage and Tax Statement,
Federal Form W-2, issued to each employee.
Line 1. Enter the Nebraska ID number which you hold or have previously held. Do not enter your Social Security number.
Line 2. Enter your federal employer ID number, if you hold one. If one has been applied for, enter “Applied For.” If no federal
employer ID number is held or has been applied for, enter your Social Security number.
Line 3. Enter the Nebraska county where your business is located.
Name and Address. Enter the name and address as last led with the Nebraska Department of Revenue (Department)
or which is printed on your present certicate, license, or permit. A new name and address should be entered in the area
immediately following line 9 of this request.
Line 5. Check the tax programs affected by this request. If there is a change in more than one program, check all
Line 6. A taxpayer closing a business must request cancellation of the tax program. A taxpayer having a seasonal type of
business may request cancellation of the tax program for the period in which no business activity is conducted. Returns must
be led for all periods ending prior to the date of cancellation.
A change in ownership or type of ownership will require a new certicate, license, or permit. When possible, the
Nebraska Tax Application, Form 20, used to obtain a new certicate, license, or permit, should accompany or precede
this request for cancellation.
Line 7. A taxpayer who previously cancelled a tax program may have it reinstated provided no change in the business has
occurred which would require a new certicate, license, or permit.
Line 8. A taxpayer ling a sales tax, use tax, or tire fee return with a tax liability of $900 to $3,000 annually may request
a quarterly ling frequency. Those with a tax liability of less than $900 annually may request an annual ling frequency.
Taxpayers ling a lodging tax return and remitting $99 or less of tax annually may request to le an annual return. Employers
withholding less than $500 annually in state income tax may request to le an annual return, rather than quarterly returns.
Changes in ling frequency are not effective until approval has been received from the Department. The taxpayer must complete
and le all preidentied returns received for periods prior to the approval.
Line 9. Enter the new name and address. The location address box cannot contain a PO Box Number; it must show the street
address. If the taxpayer wants a return to be mailed to a preparer or another person, the name and mailing address should be
completed to show this change.
Line 11. Give a detailed explanation of the reason for this request. If there has been a change in ownership, give the name and
address of the new owner.
Signature. This request must be signed by the owner, partner, member, corporate ofcer, or other individual authorized to sign
by a power of attorney on le with the Department.