Form 126 - Registration Change Request
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DLN (DOR USE ONLY)
MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
126
Please print on white paper only
PO BOX 3300, JEFFERSON CITY, MO 65105
REGISTRATION CHANGE REQUEST
(REV. 02-2013)
PLEASE USE THIS FORM TO MAKE CHANGES TO YOUR SALES/USE TAX, EMPLOYER WITHHOLDING TAX, CORPORATE INCOME/FRANCHISE
TAX, OR EXEMPTION REGISTRATION RECORDS. NOTE: PLEASE TYPE OR PRINT.
SALES/USE, EMPLOYER WITHHOLDING OR CORPORATE INCOME/FRANCHISE TAX NUMBER
____ ____ ____ ____ ____ ____ ____ ____
FEDERAL EMPLOYER IDENTIFICATION NUMBER
____ ____ ____ ____ ____ ____ ____ ____ ____
BUSINESS OWNER/ORGANIZATION NAME CURRENTLY ON FILE (ENTER CORPORATION NAME IF APPLICABLE)
PHONE NUMBER
(___ ___ ___) ___ ___ ___ - ___ ___ ___ ___
BUSINESS OWNER/ORGANIZATION ADDRESS CURRENTLY ON FILE
CITY
STATE
ZIP CODE
COUNTY
___ ___ ___ ___ ___
PLEASE MAKE THE FOLLOWING CHANGE(S) IN MY REGISTRATION RECORDS: (COMPLETE ALL APPROPRIATE ITEMS)
1. CHANGE OWNER NAME TO: (IF NAME CHANGE IS DUE TO A CHANGE IN OWNERSHIP A MISSOURI TAX REGISTRATION APPLICATION MUST BE COMPLETED.)
REASON FOR NAME CHANGE (PLEASE CHECK ONE)
NEW OWNERSHIP
NAME CHANGE ONLY
CITY
STATE
ZIP CODE
COUNTY
2. CHANGE OWNER ADDRESS TO:
__ __ __ __ __
3. CHANGE BUSINESS NAME (DOING BUSINESS AS) TO:
4.
ADD
DELETE RETAIL LIQUOR SALES ON THIS BUSINESS
5. CHANGE OF RESPONSIBLE PERSONS, PARTNERS, OFFICERS, OR MEMBERS: (ALL INFORMATION IS REQUIRED. ATTACH SUPPLE-
MENTAL LIST IF NECESSARY.) Adding persons indicates they have direct supervision or control over tax matters. (If adding or deleting partners from
a partnership account, all partners must sign this form including the partner being deleted or added. If deleting partners and only one partner remains,
you must apply for a new tax number. Close your partnership account and complete Form 2643 to apply for a new sole owner account.)
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
COUNTY
ADD
CITY
STATE
ZIP CODE
DELETE
___ ___ ___ ___ ___
BIRTHDATE(MM/DD/YYYY)
SOCIAL SECURITY NUMBER
FEIN
EFFECTIVE DATE OF TITLE CHANGE
___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
COUNTY
ADD
CITY
STATE
ZIP CODE
DELETE
___ ___ ___ ___ ___
BIRTHDATE(MM/DD/YYYY)
SOCIAL SECURITY NUMBER
FEIN
EFFECTIVE DATE OF TITLE CHANGE
___ ___ ___ ___ ___ ___ ___ ___ ___
__ __ / __ __ / __ __ __ __
___ ___ ___ ___ ___ ___ ___ ___ ___
__ __ / __ __ / __ __ __ __
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
COUNTY
ADD
CITY
STATE
ZIP CODE
DELETE
___ ___ ___ ___ ___
BIRTHDATE(MM/DD/YYYY)
SOCIAL SECURITY NUMBER
FEIN
EFFECTIVE DATE OF TITLE CHANGE
___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
ALL INFORMATION IS REQUIRED. ATTACH A SUPPLEMENTAL LIST IF NECESSARY.
6. CHANGE SALES/USE TAX FILING FREQUENCY TO:
Effective Date: ____________________________________________
MONTHLY (SALES TAX $500 OR MORE PER MONTH)
QUARTERLY (SALES TAX LESS THAN $500 PER MONTH)
ANNUALLY (SALES TAX LESS THAN $100 PER QUARTER)
7. CHANGE EMPLOYER WITHHOLDING TAX FILING FREQUENCY TO:
Effective Date: ____________________________________________
MONTHLY (WITHHOLDING TAX $500 OR MORE PER MONTH)
ANNUALLY (WITHHOLDING TAX LESS THAN $45 PER QUARTER)
QUARTER/MONTHLY (WITHHOLDING TAX OVER $9,000 PER MONTH) (Required to pay electronically)
QUARTERLY (WITHHOLDING TAX LESS THAN $500 PER MONTH)
For more information, visit
DOR-126 (02-2013)
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