Business Discontinuation Form - The City Of Pittsburgh
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1The City of Pittsburgh
Business Discontinuation Form
Department of Finance
REV (10/14)
Please print clearly using blue or black ink.
Type of Business Entity:
SOLE PROPRIETORSHIP
City ID / Account #:
Federal EIN / SSN:
PARTNERSHIP
CORPORATION
Legal Name:
S‐ CORPORATION
Trade Name:
LLC (SINGLE MBR, PARTNERSHIP, CORP, ETC)
Street Address:
NON‐PROFIT
City / State / Zip:
OTHER
HAS THE BUSINESS BEEN PERMANENTLY CLOSED?
YES
NO
IF YES, ENTER THE FINAL DATE OF BUSINESS ACTIVITY:
HAS THE BUSINESS BEEN SOLD?
YES
NO
IF YES, ENTER DATE OF SALE:
ENTER NAME(S) OF THE NEW OWNERS:
HAS THE BUSINESS MOVED OUTSIDE THE CITY OF PITTSBURGH?
YES
NO
IF YES, WHAT IS THE ADDRESS OF THE NEW LOCATION?
DATE OF MOVE:
WILL BUSINESS ACTIVITY BE CONDUCTED IN PITTSBURGH AFTER THE MOVE?
YES
NO
*NOTE: IF A BUSINESS IS NO LONGER LOCATED IN THE CITY OF PITTSBURGH LIMITS, BUT PERFORMS ANY TYPE OF SERVICE - CONTRACTUAL OR
OTHERWISE WITHIN CITY LIMITS, THAT BUSINESS MAY STILL HAVE TAX LIABILITY DUE TO PITTSBURGH.
IF YES, BRIEFLY DESCRIBE:
YES
NO
HAS THE BUSINESS ACQUIRED THE SERVICES OF A PAYROLL AGENT TO FILE YOUR RETURNS?
IF YES, NAME OF PAYROLL AGENT:
PAYROLL AGENT FEDERAL EIN:
AFFIRMATION:
I,
,
(PLEASE PRINT – OWNER / OPERATOR / OFFICER)
OF
(BUSINESS NAME)
DO HEREBY AFFIRM THAT THIS DOCUMENT HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND
BELIEF, IS TRUE, CORRECT AND COMPLETE.
DATE:
SIGNATURE:
DAYTIME PHONE:
EMAIL ADDRESS:
MAIL COMPLETED FORM TO: TAX INVESTIGATIONS, DEPT. OF FINANCE, CITY OF PITTSBURGH,
414 GRANT ST. RM 209, PITTSBURGH PA 15219
FAX: 412-255-6821
FOR INFORMATION: 412-255-2508
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