Form 126- Registration Change Request-Missouri Department Of Revenue Taxation Bureau
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1
2MISSOURI DEPARTMENT OF REVENUE
DLN (DOR USE ONLY)
FORM
TAXATION BUREAU
126
Reset Form
Print Form
PO BOX 3300, JEFFERSON CITY, MO 65105
REGISTRATION CHANGE REQUEST
(REV. 5-2007)
PLEASE USE THIS FORM TO MAKE CHANGES TO YOUR SALES/USE TAX, EMPLOYER WITHHOLDING TAX, CORPORATE INCOME / FRANCHISE
TAX, OR EXEMPTION REGISTRATION RECORDS. NOTE: PLEASE TYPE OR PRINT.
SALES/USE EMPLOYER WITHHOLDING TAX EXEMPTION NUMBER OR CORPORATE INCOME / FRANCHISE TAX NUMBER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
BUSINESS OWNER/ORGANIZATION NAME CURRENTLY ON FILE (ENTER CORPORATION NAME IF APPLICABLE)
PHONE NUMBER
BUSINESS OWNER/ORGANIZATION ADDRESS CURRENTLY ON FILE
CITY
STATE
ZIP CODE
COUNTY
PLEASE MAKE THE FOLLOWING CHANGE(S) IN MY REGISTRATION RECORDS: (COMPLETE ALL APPROPRIATE ITEMS)
1. CHANGE OWNER NAME TO:
(IF NAME CHANGE IS DUE TO A CHANGE IN OWNERSHIP A MISSOURI TAX REGISTRATION APPLICATION MUST BE COMPLETED.)
NOT APPLICABLE ON EXEMPTIONS.
REASON FOR NAME CHANGE (PLEASE CHECK ONE)
NEW OWNERSHIP
NAME CHANGE ONLY
2. CHANGE OWNER ADDRESS TO:
CITY
STATE
ZIP CODE
COUNTY
3. CHANGE BUSINESS NAME (DOING BUSINESS AS) TO:
4.
ADD
DELETE
RETAIL LIQUOR SALES ON THIS BUSINESS
5. CHANGE OF RESPONSIBLE PERSONS, PARTNERS, OFFICERS, OR MEMBERS: (ALL INFORMATION IS REQUIRED. ATTACH A SUPPLEMENTAL LIST IF NECESSARY.)
(If adding or deleting a partner from a partnership account, all partners must sign this form including the partner being deleted/added. If deleting partners and only one partner remains, you must apply for a new
tax number. Close your partnership account and complete Form 2643 to apply for a new sole owner account.)
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
CITY
STATE
ZIP CODE
ADD
DELETE
BIRTHDATE
SOCIAL SECURITY NUMBER OR FEIN
COUNTY
EFFECTIVE DATE OF TITLE CHANGE
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
CITY
STATE
ZIP CODE
ADD
DELETE
BIRTHDATE
SOCIAL SECURITY NUMBER OR FEIN
COUNTY
EFFECTIVE DATE OF TITLE CHANGE
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
CITY
STATE
ZIP CODE
ADD
DELETE
BIRTHDATE
SOCIAL SECURITY NUMBER OR FEIN
COUNTY
EFFECTIVE DATE OF TITLE CHANGE
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
CITY
STATE
ZIP CODE
ADD
DELETE
BIRTHDATE
SOCIAL SECURITY NUMBER OR FEIN
COUNTY
EFFECTIVE DATE OF TITLE CHANGE
NAME (LAST, FIRST, MIDDLE INITIAL)
TITLE
HOME ADDRESS
CITY
STATE
ZIP CODE
ADD
DELETE
BIRTHDATE
SOCIAL SECURITY NUMBER OR FEIN
COUNTY
EFFECTIVE DATE OF TITLE CHANGE
ALL INFORMATION IS REQUIRED. ATTACH A SUPPLEMENTAL LIST IF NECESSARY.
This form is available upon request in alternative accessible format(s).
DOR-126 (5-2007)
MO 860-1659 (5-2007)
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