Change Of Address Notifi Cation For Individual Income Tax Form - Office Of State Tax Commissioner - State Of North Dakota

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STATE OF NORTH DAKOTA
OFFICE OF STATE TAX COMMISSIONER
STATE CAPITOL, 600 E. BOULEVARD AVE., DEPT. 127, BISMARCK, NORTH DAKOTA 58505-0599
701-328-2770
FAX 701-328-3700
Hearing/Speech Impaired 800-366-6888
C
F
ORY
ONG
C
OMMISSIONER
Change of Address Notifi cation for Individual Income Tax
You may use this form to notify our agency when you have changed your home mailing address. If this change of address
also affects the mailing address for your children who fi led income tax returns, each child will need to complete and fi le a
separate Change of Address form. If you are a representative signing for a taxpayer, also attach a copy of your power of
attorney.
Date
Daytime Phone Number
Hours that you can be reached at this number
Name: (last name, fi rst name, middle initial)
Social Security No.
Spouse’s Name (last name, fi rst name, middle initial)
Social Security No.
Old Address (# Street, City, State and Zip Code)
Apt. #
New Mailing Address (# Street, City, State and Zip Code)
Apt. #
PLEASE
SIGN
____________________________________________________________________________
HERE
Signature of Taxpayer
Date
(Do not print)
Instructions
Purpose of this form
Signature
This form must be signed by the taxpayer
You may use this Change of Address
or a representative of the taxpayer making
Form to notify the Offi ce of State Tax
Commissioner if you changed your mailing
the request for the address change. A
representative is a person who has a valid
address. If this change also affects the
power of attorney to handle tax matters or
mailing address for your children who
fi led income tax returns with this offi ce,
is otherwise authorized to sign tax returns
for the taxpayer. If you are a representative
each child will need to complete and fi le a
signing for the taxpayer, also attach a copy
Change of Address Form with this offi ce.
of your power of attorney.
Addresses
Be sure to include any apartment, room or
Where to Send Address Change
Mail this completed form to:
suite number in the space provided. If you
are entering a foreign address, follow the
Offi ce of State Tax Commissioner
country’s practice for entering the postal
600 E. Boulevard Ave., Dept. 127
code. Do not abbreviate the country’s
Bismarck, ND 58505-0599
name.
28250

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