Change Of Name Or Address Withholding Tax Form - State Of Arkansas
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1STATE OF ARKANSAS
CHANGE OF NAME OR ADDRESS FORM
WITHHOLDING TAX
This form is to be used for the following changes. Please check one or more of the following
boxes:
A change in the name of your business
RESET FORM
A change in your mailing address
A change in the physical location of your business
Please type or print the information below:
Federal Identification Number
Previous Name
New Name
Previous Address/Location
New Address/Location
Effective Date of change
Signature
Title
Typed or Printed Name of Individual Above
Date
Phone Number
NOTE: A change in your FEIN requires a new
MAIL FORM TO:
registration, Form AR-4ER, to be completed. If you
Withholding Tax Branch
need
a
new
registration,
log
on
to
P. O. Box 8055
tax_wh_forms.html or check the box below and
Little Rock, AR 72203-8055
(501) 682-7290 Telephone
a form will be mailed to the new address.
(501) 683-1036 Fax
(R 04/06)
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