Form C1-05 - Request For Change - Delaware Division Of Revenue
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1DELAWARE DIVISION OF REVENUE
REQUEST FOR CHANGE
P.O. BOX 8750
New Booklets Will Be Issued for
WILMINGTON, DE 19899-8750
ID No. & Tax Year Ending Changes Only
CORRECT TAX YEAR ENDING DATE
ACCOUNT NUMBER CHANGE
EFFECTIVE DATE
REASON FOR CHANGE
CORRECT BUSINESS LOCATION ADDRESS
ACCOUNT NUMBER
C1-05
NAME
Out of Business
Date
BUSINESS MAILING ADDRESS
ADDRESS
CITY
STATE
ZIP
CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE
NAME
ADDRESS
X
AUTHORIZED SIGNATURE
CITY
STATE
ZIP
/
/
DATE
TELEPHONE NUMBER
DELAWARE DIVISION OF REVENUE
REQUEST FOR CHANGE
P.O. BOX 8750
New Booklets Will Be Issued for
WILMINGTON, DE 19899-8750
ID No. & Tax Year Ending Changes Only
CORRECT TAX YEAR ENDING DATE
ACCOUNT NUMBER CHANGE
EFFECTIVE DATE
REASON FOR CHANGE
CORRECT BUSINESS LOCATION ADDRESS
ACCOUNT NUMBER
C1-05
NAME
Out of Business
Date
BUSINESS MAILING ADDRESS
ADDRESS
CITY
STATE
ZIP
CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE
NAME
ADDRESS
X
AUTHORIZED SIGNATURE
CITY
STATE
ZIP
/
/
DATE
TELEPHONE NUMBER
DELAWARE DIVISION OF REVENUE
REQUEST FOR CHANGE
P.O. BOX 8750
New Booklets Will Be Issued for
WILMINGTON, DE 19899-8750
ID No. & Tax Year Ending Changes Only
CORRECT TAX YEAR ENDING DATE
ACCOUNT NUMBER CHANGE
EFFECTIVE DATE
REASON FOR CHANGE
CORRECT BUSINESS LOCATION ADDRESS
ACCOUNT NUMBER
C1-05
NAME
Out of Business
Date
BUSINESS MAILING ADDRESS
ADDRESS
CITY
STATE
ZIP
CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE
NAME
ADDRESS
X
AUTHORIZED SIGNATURE
CITY
STATE
ZIP
/
/
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