State of Connecticut
Department of Revenue Services
TPG-189 (Rev. 07/15)
Request Change of Administrator in TSC
Complete this form in blue or black ink only.
Purpose: Use TPG-189 to appoint a new administrator of your current Department of Revenue Services (DRS), Taxpayer
Service Center (TSC) account. Complete a seperate TPG-189 for each TSC account that you need to change.
Part 2 - Veri cation
Provide information as shown on a previously led tax return (do not use information from the return you are attempting to
le). The TSC account administrator will not be changed if the following information is not accurately completed.
1. Enter the tax type of the return previously led. 1.
2. Enter the tax period of the return previously led.(MM/DD/YYYY) 2.
3. Enter the amount of tax liability of the return previously led. 3.
Part 1 - Business Information
In order to authenticate your identity, print all information exactly as shown on your Connecticut tax account.
Business name Connecticut tax registration number
Name of current TSC account administrator Business phone number
Address Number and street PO Box City or town State ZIP code
Part 3 - New Administrator
Name of NEW TSC account administrator New administrator’s phone number
Part 4 - Con rmation Method
Indicate how DRS should send your new temporary password. Select only one method below.
Mail to the same mailing address listed in Part 1 - Business Information.
Email to the following email address:
Fax to the following FAX number:
How to Submit Request
Submit your completed request using one of the following
FAX to: 860-297-4761
MAIL to: Department of Revenue Services
Electronic Commerce Unit
PO Box 2937
Hartford CT 06104-2937
Authorized signature Title
Print authorized name Date
Email Address Phone
Sign Here
Keep a copy
for your
Declaration: I declare under penalty of law that I have examined this document and, to the best of my knowledge and belief, it is true, complete, and correct.
I understand that the penalty for willfully delivering false information to the DRS is subject to a ne of not more than $5,000, or imprisonment for not more than
ve years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
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