Form 163 - Notice Of Change Or Discontinuance Form - 2010
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Michigan Department of Treasury
Account Number
163 (Rev. 8-10)
Notice of Change or Discontinuance
Check this box if you have not received
a current set of SUW forms.
Legal Business Name and Address
Mailing Name and Address
Change Our Legal Business Name and/or Address To:
Change our Mailing Name and/or Address To:
(If P.O. Box Number, you must include a street address)
Use this form only if you discontinued or made changes to your business. Complete this form and mail to: Michigan Department of Treasury,
Registration Unit, P.O. Box 30778, Lansing, MI 48909-8278. Forms can also be faxed to (517) 636-4520.
The following information is requested to complete the change or discontinuance of your business. Complete all that apply.
1. Correct Federal Employer Identification Number: _____________________________________________
The business was changed to a:
LLC
Ltd. Partnership
Sole Proprietorship
Corporation
Partnership
Discontinuance date of your business: _________________________
2.
Enter on the front of Form 163 your contact address after the discontinuance or sale of your business.
Date on which part or all (circle one) of the business was sold: __________________________________
Buyer’s name and address: ______________________________________________________________
From the following list, check the appropriate box to add or delete a tax or license from your registration (check all that apply):
3.
ADD
DEL
ADD
DEL
ADD
DEL
Sales Tax
Income Tax Withholding **
Motor Fuel Tax License
Use Tax
Motor Carrier License
Tobacco Products Tax License
Michigan Business Tax
LPG Dealer License
Flow-Through Withholding
** To add withholding, complete Application for Registration (Form 518) available at
Enter the correct business name on page 1 of this form if it is different than the name listed.
4.
If you are a seasonal business, months your business is open:
5.
Attach to this form additional information explaining other changes (e.g. mergers) to your business.
6.
Effective date(s) for the changes provided: _______________________________________________
7.
Preparer’s Signature
Preparer’s Telephone Number
Date
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Parent category: Financial