Notice Of Change Or Discontinuance Of Business Form - Springfield Income Tax Department

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NOTICE OF CHANGE OR DISCONTINUANCE OF BUSINESS
FEIN:
CHANGE EFFECTIVE AS OF:
CURRENT BUSINESS NAME:
NAME CHANGED TO:
D.B.A.:
D.B.A. CHANGED TO:
CURRENT BUSINESS ADDRESS:
BUSINESS ADDRESS CHANGED TO:
MAILING ADDRESS :
MAILING ADDRESS CHANGED TO:
Place an 'X' in all boxes that apply. Complete all information for the change. Write any
Instructions
comments or explanations on the back of this form.
1 . IRS has assigned use a federal identification number: _________________
2 . Our federal employer identification number is wrong.
The correct number is:________________
3 . a. We have incorporated. Our Corporate name is: _______________________________________
b. Our corporate federal employer identification number is: ________________________________
4 . Discontinue our withholding tax registration. We no longer have business activity in Springfield.
We closed our business on: ________________
We sold our entire business on: _________ or we sold part of our business on: ____________
To: ______________________________________________________
Their FEIN is: _______________________
5 . Address and phone number where we may contact you following discontinuance of your business:
6 . Give name, address and phone number of person who will have custody of your books and records
of the discontinued business: _______________________________________________________
7 . Change in ownership (Please explain on the back of this form).
8 . Effective ____________, we have changed our fiscal year ending form: __________ to: _________
9 . Other changes (Please explain on back of this form).
x
SIGNATURE OF PREPARER
PRINT NAME & TITLE
DATE
PHONE NUMBER
MAIL THIS FORM TO: SPRINGFIELD INCOME TAX DEPARTMENT, 601 AVENUE A, SPRINGFIELD, MI 49037-7774
EXCEL-NOTICE OF CHANGE OR DISCONTINUANCE OF BUSINESS9/4/2008

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