Form R-3 - Registration Information Change Request

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Form R-3
REGISTRATION INFORMATION CHANGE REQUEST
It is faster and easier to change your business registration information online at If you prefer to request
the Department make these changes please read the instructions carefully as you complete this form. For assistance please call
(804) 367-8057. NOTE: If there has been a change in ownership and you are the new owner, do not complete this form.
You must register at or complete and submit the Form R-1.
If requesting the changes via paper; Fax the completed form to (804) 367-2603 or mail to:
Virginia Department of Taxation
PO Box 1114
Richmond, VA 23218-1114
FOR ALL CHANGES YOUR VIRGINIA ACCOUNT NUMBER IS REQUIRED and, if applicable, your Federal Employer
ID Number.
Virginia Account Number
Federal Employer ID (FEIN)
NAME, CONTACT AND/OR ADDRESS CHANGE(S) - Complete the information in both columns.
Name Change
LEGAL BUSINESS NAME
NEW LEGAL BUSINESS NAME
TRADING-AS NAME
NEW TRADING-AS NAME
Contact Phone Number Change
CONTACT PHONE NUMBER
NEW CONTACT PHONE NUMBER
Change In Physical Business Location
Effective Date __________________________________
PHYSICAL STREET ADDRESS
NEW PHYSICAL STREET ADDRESS
CITY
ST
ZIP
CITY
ST
ZIP
Change In Mailing Address
MAILING ADDRESS
NEW MAILING ADDRESS
CITY
ST
ZIP
CITY
ST
ZIP
BUSINESS CLOSED, NO LONGER OPERATING
Effective Date __________________________________
(e.g., Completely out of business, Business type structure changed, or Corporation merged)
NO LONGER LIABLE FOR TAX TYPE(S)
(e.g., Sales, Withholding, etc.)
___________________________ Effective Date ______________________
___________________________ Effective Date ______________________
___________________________ Effective Date ______________________
VA DEPT. OF TAXATION
1501225
(REV 02/14)

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