74-157
For Comptroller’s use only
(Rev.10-14/12)
PRINT FORM
CLEAR FORM
Payee Change Request
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have
on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request
Number Change / Merge
information for review or to request error correction, contact us at
1-800-531-5441, ext.
6-8138.
SSN - 9 digits
1. Texas Identification Number (TIN)
ITIN - 9 digits
Change
EIN - 9 digits
Merge
From
To
TIN - 11 digits
Master Changes
(11 digits)
2. Texas Identification Number (TIN)
3. Payee name
4. Change ownership type code to
5. Add/Change sole owner’s name to
*
6. Add/Change sole owner’s Social Security number (SSN)
or Individual Taxpayer Identifictaion Number (ITIN) to:
(9 digits)
7. Enter Add/Change partnership information to:
Partner 1:
Name
*
SSN
(9 digits)
Federal Privacy Act Statement
Disclosure of your Social Security number
is required and authorized under law, for the
ITIN
(9 digits)
purpose of tax administration and identification
of any individual affected by applicable law,
(9 digits)
EIN
42 U.S.C. sec. 405(c)(2)(C)(i); Texas Govt.
Code Sections 403.011, 403.056, and 403.078.
Release of information on this form in response
Partner 2:
Name
to a public information request will be governed
by the Public Information Act, Chapter 552,
*
SSN
(9 digits)
Government Code, and applicable federal law.
ITIN
(9 digits)
(9 digits)
EIN
8. Add/Change Texas Secretary of State's file number to
Mail Code Changes
(1 form per mail code)
9. Texas Identification Number (TIN)
10. Mail code
(If unknown, leave blank.)
11. Payee name
12. Change payee name to
13. Change payee address to
City
State
ZIP code
Zone code
(For agency use only)
14. Add/Change telephone number to
For Agency Use Only
17. Add/Change employing agency number to
20. Hold bypass (1, 2, D)
15. Change security type to 2
18. Change master status (A, I) to
21. Unmask TIN (Y, D)
16. Change SIC code to
19. Change mail code status (A, I) to
Authorized Signature
(Payees should submit this form to the state agency with which they are conducting business.)
22. Authorized signature (Applicant or state agency representative - Required)
23. Phone number (Area code and number - Required)
24. Date
25. Agency name
26. Agency number
27. Comments