Form Ador 50-4004 - Update Card
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1DEPARTMENT OF REVENUE UPDATE CARD
Use this card to provide notification of changes to sales tax or withholding accounts. Please indicate any changes in the business that will affect your licenses with the Department of
Revenue. The license type and number, your taxpayer identification number/social security number and your signature are required to authorize any changes. Please return this form along
with your sales tax or withholding return, or mail to License & Registration Section, P O Box 29069, Phoenix AZ 85038-9069. Please note: There is a $12 fee for status changes 2 or 3 on
your Transaction Privilege (Sales) Tax License. Additional fees for city licenses vary by city ($1 to $20). You will be billed for underpayment of fees. If you have any questions, please call
(602) 542-4576 in Phoenix, or 800-643-6494 toll-free in state.
License number:
Sales
Withholding
PC
TRAN CODE 800
IF YOU NEED MORE WITHHOLDING COUPONS, PLEASE CIRCLE
1. Name of business:
THE AMOUNT NEEDED PER QUARTER:
2. Change business name to:
3
6
9
12
15
18
21
3. Change business address to:
TO CANCEL YOUR LICENSE, PLEASE CHECK HERE:
You are requested to return your State Transaction Privilege
4. Change mailing address to:
(Sales) Tax License. Also, please indicate the date you ceased
5. Business phone:
Home phone:
doing business:
6.
Federal Employer Identification Number or
Social Security Number:
IF YOU NEED AN APPLICATION FOR A NEW LICENSE, PLEASE
CHECK HERE:
New licenses are needed under the following conditions: Business
ownership change, to add/delete spouse (sole ownership), to change
7. Suspend license: From:
To:
to partnership/sole owner/corporation or when you change county
8. Add or delete city(ies) licensed for:
location of your business sales tax license only).
Effective date of change:
Signature: ________________________ Date: _________________
ADOR 50-4004(5/95)
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Parent category: Financial