WV/COA
Orig. 03-17 Individual Change of Address
West Virginia
State Tax
Department
►Do not use this form for changing business aDDress
Individuals may use this form to notify the West Virginia State Tax Department of a change in address. To complete this form, provide the information
requested. This form must be signed and dated, including spouse (if applicable). Incomplete AND illegible forms will not be processed. This form is
intended for use by individuals. If you wish to change a business address, please register to use or logon to MyTaxes at mytaxes.wvtax.gov. Instructions
for submitting address change for businesses may be found by accessing Help, Business/Tax Professional, Account/Names/Addresses section.
First Name MI Last Name Last 4 digits of SSN or 8 Digit Account ID
First Name (SPOUSE, if applicable) MI Last Name (Spouse) Last 4 digits of SSN or 8 Digit Account ID
NEW Resident Address Unit/APT
City State Zip/Postal Code County
NEW Mailing Address (If different from resident address) Unit/APT
City State Zip/Postal Code County
FORMER Resident Address Unit/APT
City State Zip/Postal Code County
FORMER Mailing Address (If different from resident address) Unit/APT
City State Zip/Postal Code County
By signing below, you are authorizing the West Virginia State Tax Department to change this address and certify to the best of your knowledge and
belief that this report is true.
Primary
Taxpayer
Signature Date
E-mail Address Daytime Phone
The West Virginia State Tax Department may contact me using the following method (mark all that apply):
E-mail YES NO Phone YES NO Mail YES NO
Spouse
Spouse’s Signature Date
E-mail Address Daytime Phone
The West Virginia State Tax Department may contact me using the following method (mark all that apply):
E-mail YES NO Phone YES NO Mail YES NO
Mail completed form to West Virginia State Tax Department, Personal Income Tax Unit, PO Box 2389, Charleston, WV 25328-2389
