Form G-5(B) - Withholding Account Change Form
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G-5(B) WITHHOLDING ACCOUNT CHANGE FORM
NEW BUSINESS LOCATION ADDRESS
GA WITHHOLDING ID
NEW MAILING ADDRESS
DO NOT WRITE “SAME” IN ABOVE. EACH CHANGE
MUST BE WRITTEN IN THE APPROPRIATE AREA.
Business Discontinued
Change in Trade Name
Date Last Wages Paid
__________________________________________________
Reason for Change ___________________________________
Business Sold
(if incorporated, submit amended charter and articles of incorporation)
Date
Sold to
No Longer Have Employees
Date Last Wages Paid
SIGNATURE
__________________________________________________
TELEPHONE NUMBER
TITLE
DATE
INSTRUCTIONS FOR COMPLETING ACCOUNT CHANGE OR DELETE FORM G-5(B)
The Account Change or Delete Form must be used to notify the Department of a change in name/address
or as notification that you are no longer liable for Georgia Withholding Tax for the reason(s) shown above.
CHANGE OF ADDRESS:
Complete appropriate box.
BUSINESS DISCONTINUED:
Check box and indicate date business closed.
BUSINESS SOLD:
Check box. Indicate date business was sold and name of new owner.
CHANGE IN TRADE NAME:
If name change is not due to a structure change, check box and indicate
new name. Include a copy of the “Articles of Amendment” from the Secretary of
State’s office.
STRUCTURE CHANGE:
Submit a completed application to obtain a new withholding number.
Attach completed G-5(B) to application as notification to cancel old number.
SIGNATURE:
Person submitting change must sign the form.
NOTE: If you had a structure change or you purchased a business, do not use forms indicating the old
withholding number. Doing so could cause incorrect posting of your payments.
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