R - 6450 Business Taxes Address Change Form

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R - 6450 (01/06)
Business Taxes
Address Change Form
Check all the boxes that this change affects:
Effective Date of Change: _____________________
Do not complete a separate address change form if the new address applies to all taxes.
Sales
Account Number: ___________________
Withholding
Account Number: ___________________
Corporate Income/Franchise
Account Number: ___________________
Other
______________
Account Number: ___________________
List appropriate tax
Legal Name ____________________________________________________________
Trade Name ____________________________________________________________
Location Address
Old Address
Street
Suite
City/State
Zip
Suite
Old Addtress
Old Street
Old Mailing City/State
Old Mailing Zip
New Address
Street
Suite
City/State
Zip
New Mailing Suite
New Mailing City/State
New Mailing Zip
New Address
New Street
Contact person and daytime telephone number
__________________________________________________________(______)_______-_______________
Mailing Address
Old Address
Street
Suite
City/State
Zip
Old Mailing Suite
Old Mailing City/State
New Mailing Zip
Old Mailing Street
Old Mailing Address
New Address
Street
Suite
City/State
Zip
New Mailing Suite
New Mailing City/State
New Mailing Zip
New Mailing Address
New Mailing Street
Contact person and daytime telephone number
__________________________________________________________(______)_______-_______________
Request must be mailed or faxed to:
Louisiana Department of Revenue
P. O. Box 201
Baton Rouge, LA 70821
Fax Number: 225-219-2348
6690

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