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Form 941p-Me - Ass-Through Entity Withholding Tax Name And Address Change Form - 2005

THIS BOOKLET CONTAINS FORMS NEEDED TO FILE AND PAY MAINE INCOME TAX

WITHHOLDING FOR NONRESIDENT PARTNERS, SHAREHOLDERS & BENEFICIARIES

2005

Withholding Account Number:

Tax Year:

This booklet contains the following forms: Pass-through Entity Return of Maine Income Tax Withheld From Owners (FORM 941P-ME) and Amended Return

of Maine Income Tax Withholding (FORM 941A-ME).

PLEASE CHECK THE PRE-PRINTED INFORMATION ON THESE DOCUMENTS FOR ACCURACY AND COMPLETENESS.

REPORT ANY ERROR by writing to:

MAINE REVENUE SERVICES

P.O. Box 9118

Augusta, ME 04332-9118

OR by calling:

MAINE REVENUE SERVICES

207-626-8475

(press 1, then option 4)

DO NOT REMOVE THE UPPER SECTION OF THIS PAGE. IT SHOULD REMAIN IN THIS BOOKLET FOR FUTURE REFERENCE.

DETACH HERE AND SUBMIT THIS PART

PASS-THROUGH ENTITY WITHHOLDING TAX

NAME AND ADDRESS CHANGE FORM

FORM 941P- ME 2005

If there has been a change in your name, address and/or telephone number, complete this form and mail it to MAINE REVENUE SERVICES.

Note: If your business is discontinued or the requirement to withhold ceases, complete the cancellation notice at the bottom of

the quarterly return.

Mail to:

Maine Revenue Services

P.O. Box 9118

Present Pass-through Withholding Account Number:

Augusta, ME 04332-9118

Present Name and Address:

New Name and Address (If Applicable):

Old Phone Number:

New Phone Number (If Applicable):

Effective Date of Change:

Remarks:

Date

Signature

Title

Telephone

Form 941p-Me - Ass-Through Entity Withholding Tax Name And Address Change Form - 2005