Change Of Address Request Form

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CHANGE OF ADDRESS REQUEST
Part 1 Complete this Part to Change your Home Mailing Address
Individual income tax returns
If your last return was a joint return and you are now establishing a residence separate from
the spouse with whom you filed that return, check here . . . . . . . . .
1. Your Name (first name, initial, last name)
1a. Your Social Security Number
2. Spouse’s name (first name, initial, last name)
2a. Spouse’s Social Security Number
3. Prior name(s)
4. Date moved (mm/dd/yyyy)
/
/
5. Old Address (number, street, apt #, city, state and zip code)
6. New Address (number, street, apt #, city, state and zip code)
Part 2 Complete this Part to Change your Business Mailing Address of Business Location
Check all boxes that this change affects:
7.
Business net profit returns
10. Date moved
/
/
8.
Employer withholding returns
9.
Business location
11. Business name
11a. EIN/FID Number
12. Old Address (number, street, room/suite #, city, state and zip code)
13. New Address (number, street, room/suite #, city, state and zip code)
Part 3 Signature
Daytime telephone number of person to contact (optional) (_____)___________
If Part 1 above was completed:
Your Signature
Date
If joint return, spouses’ signature
Date
If Part 2 above was completed: (
Owner, Officer or Representative must sign)
Your Signature
Date
Please print name
Title
City of Springboro
Tax Department
320 West Central Avenue
Springboro, OH 45066
Phone: (937) 748-9701
Fax: (937) 748-6185

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