Form Ar-40 - Combined Registration Change Form - Arkansas Combined Registration - Arkansas

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AR-40
Print Form
Combined Registration Change Form
Use this form to change tax account information
(if registered with ATAP, you may perform this action online at )
FEIN or SSN
Legal Name of Business
LEGAL / CORPORATION INFORMATION
Current
Change
Legal Name of Business
NEW Legal Name of Business
Physical Location Address
NEW Physical Location Address
Mailing Address
NEW Mailing Address
ACCOUNT INFORMATION
Current
Change
Sales / Use
WH
Other
Account Physical Location Address
NEW Account Physical Location Address
Account Mailing Address
NEW Account Mailing Address
CONTACT INFORMATION
Sales
Withholding
Other:
Sales
Withholding
Other:
Add
Change
Delete
Add
Change
Delete
Contact Name
Contact Name
Phone Number
Phone Number
Email Address
Email Address
Sales
Withholding
Other:
Sales
Withholding
Other:
Add
Change
Delete
Add
Change
Delete
Contact Name
Contact Name
Phone Number
Phone Number
Email Address
Email Address
Effective Date of Change
Signature of Owner, Partner, or Corporate Officer
Date
Typed or Printed Name, of Owner, Partner, or Corporate Officer:
Date:
Note: When physical address or legal name changes are requested, all state business tax permits must be surrendered with this form before any changes
will be approved.
Mail this form to: Arkansas Combined Registration, PO Box 8123, Little Rock, AR 72203-8123
eMail: register.tax@dfa.arkansas.gov
Rev. 04/27/2010

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