Registration Change Form - Centralized Taxpayer Registration Unit
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1Registration Change Form
For any change of Trade Name, Address, Ownership, or Telephone Number, check applicable boxes and provide information below.
Send completed form in a separate envelope to the address listed below:
[ ] New Business Location/ Trade Name
[ ] Business Closed
Name
[ ] Business Sold
Address
_______
Date Sold/Closed
_____
City, State, Zip
_______
[ ] Name, Address, and Phone Number of Owners
Phone Number
Name
____________
County
_______
Address
____________
[ ]
New Mailing Address
City, State, Zip
____________
Address
_______
Phone Number
____________
City, State, Zip
_______
SEND CHANGES TO:
Centralized Taxpayer Registration Unit
PO Box 49512
Phone Number
Atlanta, GA 30359-1512
rev. 01/03
PERF
FACE 3
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Parent category: Financial