Form Cr-108 - Notice Of Business Closure Form - Kansas Department Of Revenue
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1KANSAS DEPARTMENT OF REVENUE
FOR OFFICE USE ONLY
CUSTOMER RELATIONS
Inactive: _______________________________
915 SW HARRISON ST
Date/Initial
TOPEKA, KANSAS 66612-1588
Audited: _______________________________
PHONE: 785-368-8222 FAX: 785-296-2073
Date/Initial
NOTICE OF BUSINESS CLOSURE
Deleted: _______________________________
Date/Initial
1.
2.
3.
__________________________
___________________________
______________________________
_________________________________
Kansas Tax Account No.
Federal Employer’s ID No.
Business Telephone Number
Officer’s Telephone Number
4.
5.
_______________________________________________
_________________________________________________________________________________
Business Name
Business Mailing Address
_________________________________________
_______________________
________________________________
City
State
ZIP
6.
7.
_______________________________________________
__________________________________________________________________________________
Owner’s/Officer’s Name
Current Address
________________________________________________________________________________________________
City
State
ZIP
9. On ______________________
, ______
this business was closed and I wish to cancel my registration for the following tax(es).
Check each box that applies and enter the specific account number for that tax.
Retailers’ Sales _____________________________
Bingo Enforcement _______________________________
Retailers’ Compensating ______________________
Dry Cleaning Surcharge ____________________________
Liquor Enforcement __________________________
Withholding ______________________________________
Liquor Drink _______________________________
_
Transient Guest Tax _______________________________
Consumer’s Use _____________________________
Vehicle Rental Tax ________________________________
Tire Excise _________________________________
Water Protection Fee ______________________________
10. Does this business currently have employees?
Yes
No If no, enter effective date:
_______________________________________
11. Has there been a transfer or a change in ownership?
N o
Yes If yes, complete lines a, b and c:
a. Trade name of new business _________________________________________________________________________
b. New owner’s name __________________________________________________________________________________
c. Starting date of new business _______________________________ Taxpayer ID No. ___________________________
12. This business has
a cash bond
an escrow bond
a surety bond
no bond
unknown
13. Have all applicable forms for the taxes marked above been filed to date of closing?
Yes
No If no, file them with this form.
14. If this is a consolidated registration, are all locations being closed?
Yes
No If no, list the specific locations to be closed
under “Remarks” on line 15.
15. Remarks and final settlement or arrangement for settlement:
_____________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
SIGN
HERE
______________________________________
______________
__________
___
_____
____
__________________________________
Signature of Retailer/Employer
Title
Date
Signature of Preparer
FOR OFFICE USE ONLY
Was the date that the business was discontinued estimated?
No
Yes If yes, give source of information: ______________
_________________________________________________________________________________________________________
Accounts receivable remain to be collected:
No
Yes If yes, tax type: __________________________________________
Mailing address: ___________________________________________________________________________________________
A Jeopardy Assessment is recommended.
No
Yes If yes, tax type: ___________________________________________
A warrant is recommended.
No
Yes
If yes, tax type: _______________________________________________________
Comments: _______________________________________________________________________________________________
Prepared by:__________________________________________
Date: ___________________________________________
1
CR-108 (Rev. 11/15)
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