Form 163 - Notice Of Change Or Discontinuance
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Michigan Department of Treasury
Account Number (FEIN or TR Number)
163 (Rev. 07-11)
Notice of Change or Discontinuance
Check this box if you have not received
a current set of SUW forms.
Use this form only if you discontinued or made changes to your business. Complete all sections that apply.
PART 1: BUSINESS INFORMATION
Legal Business Name and Address
Mailing Name and Address
Change Our Legal Business Name and/or Address To:
Change our Mailing Name and/or Address To:
(If P.O. Box Number, you must include a street address)
PART 2: DISCONTINUED BUSINESS
. Complete Part 2 and sign at the bottom of this form.
DISCONTINUE TAX TYPES LISTED IN PART 3.
Effective Date:
Applicable tax types listed in Part 3 will be removed from your business registration effective this date.
PART 3: CHANGE TAX TYPE
From the following list, check the appropriate box to add or delete a tax or license from your registration (check all that apply):
ADD
DEL
ADD
DEL
ADD
DEL
Sales Tax
Income Tax Withholding **
Motor Fuel Tax License
Use Tax
Motor Carrier License
Tobacco Products Tax License
Corporate Income Tax
LPG Dealer License
Flow-Through Withholding
** To add withholding, complete Application for Registration (Form 518) available at
PART 4: OTHER BUSINESS CHANGES OR INFORMATION
1. If you are a seasonal business, months your business is open:
2. Attach to this form additional information explaining other changes (e.g. mergers) to your business.
3. Effective date(s) for the changes provided: _______________________________________________
4. Correct Federal Employer Identification Number: ______________________________________________
5. This business was changed to a:
LLC
Ltd. Partnership
Sole Proprietorship
Corporation
Partnership
6. Enter in Part 1 your contact address after the discontinuance or sale of your business.
7. Date on which part or all (circle one) of the business was sold: __________________________________
8. Buyer’s name and address: ______________________________________________________________
Preparer’s Signature
Preparer’s Telephone Number
Date
Complete this form and mail to:
Michigan Department of Treasury
Registration Unit
P.O. Box 30778
Lansing, MI 48909-8278.
Forms can also be faxed to (517) 636-4520.
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