Form Ct-8822 Change Of Address Department Of Revenue Services
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1
2Department of Revenue Services
Form CT-8822
State of Connecticut
PO Box 2937
Change of Address
Hartford CT 06104-2937
(Rev. 12/10)
Complete in blue or black ink only. This form can be fi led electonically; see instructions on reverse. Do not attach this form to your return.
Part I
Complete this part to change individual income tax, estate tax, and gift tax address information.
Check all boxes this change affects:
1.
Connecticut individual income tax returns (Forms CT-1040 and CT-1040NR/PY)
If your last return was a joint return and you are now establishing a residence separate
from the spouse with whom you fi led that return, check here. . ............................................................................
2.
Connecticut estate and gift tax return (Form CT-706/709)
3a. Your fi rst name, middle initial, and last name
3b. Your Social Security Number
4a. Spouse’s fi rst name, middle initial, and last name
4b. Spouse’s Social Security Number
5. Prior name(s): See instructions.
6a. Your old address (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Apt. No.
6b. Spouse’s old address, if different from Line 6a (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Apt. No.
7.
New address (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Apt. No.
8. Effective date of address change
9. Reason for address change
Part II
Complete this part to change business mailing address or business location.
Check all boxes this change affects:
10.
Other income tax returns (Form CT-1041, Form CT-1065/CT-1120SI, etc.)
11.
Business returns (Form OP-424, Form OS-114, etc.)
12.
Business location
13a. Business name
13b. Connecticut Tax Registration Number
13c. Federal Employer Identifi cation Number
14. Old mailing address (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Room number
15. Old business location (number, street, city or town, state, and ZIP code): If a PO Box or foreign address, see instructions.
Room number
16. New mailing address (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Room number
17. New business location (number, street, city or town, state, and ZIP code): If a PO box or foreign address, see instructions.
Room number
18. Effective date of address change
19. Reason for address change
Part III
Signature
Your signature
Date
Spouse’s signature (if joint return)
Date
Please
sign
If Part II completed, signature of owner, offi cer, or representative
Date
Title
here.
Daytime telephone number (optional)
(
)
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