Change In Name, Address And/or Federal I.r.s. Number Form

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COMPLETE FORM AND RETURN
ONLY IF: THERE IS ANY CHANGES IN YOUR FEDERAL I.R.S. NUMBER, NAME,
ADDRESS, OR OWNERSHIP (WITH EFFECTIVE DATE), AND IF YOUR ARE
REQUESTING TO SUSPEND YOUR ACCOUNT.
Change in Name, Address and/or Federal I.R.S. Number
Legal Name Change ________________________________________Date__________
)
(If name change is due to Incorporation, A Status Report Form (ES-802) must be completed
Business Name Change____________________________________________________
Mailing Address Change___________________________________________________
Address
_______________________________________________________________________
New Mexico
City
State
Zip
NM Business Location
Address Change___________________________________________________________
Street Address
__________________________________________________________________________________________
City
State
Zip
NOTE: If mailing address is the same as your business location address write “same”.
Telephone Number Change_(
)_______________________
Federal I.R.S.; Employer Identification No. Change_______________________________
State Reason For Change(s)__________________________________________________
Request Account Suspension Because:
___________Closed Business
Last Date For Paying Wages___________________
___________Operating Without Employees
Last Date For Paying Wages___________________
___________Sold Business
NOTE: If you sold your business complete change in Ownership section below and provide your forwarding address in the
mailing address change section above.
Change In Ownership:
Date Sold______________Date New Owner(s) Took Over Business___________________
New Owner(s) Legal Name____________________________________________________
Business Name___________________________________________________
___________________________________________
Address
_________________________________________
New Mexico
City
State
Zip
Telephone Number_(
)_____________________
Are You Continuing to Operate a Business in New Mexico? Yes____ No____
If your answer is no give last date you paid wages________________________
If your answer is yes, please complete a Status Report (ES-802 form) on current business.
_______________________
Authorized Signature
Title
__________________________________
Date

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