Change Of Status Report
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1St. John the Baptist Parish
*Enter Information in
OFFICIAL USE ONLY
Boxes Only
CHANGE OF STATUS REPORT
ACCOUNT NUMBER:
RECORDED BY:
DATE:
Type of Change:
A. Business discontinued/closed
B. Change of name
C. Change of mailing and/or physical address
D. Change of entity type
Effective date of change:
E. Business sold*
*Name of new owner:
A. Reason for closure:
B. New Legal Name of business:
New Trade Name of business:
C.
New Physical Address:
Physical Address
City
State
Zip code
Phone
Parish
New Mailing Address:
(If same as physical. write "same")
Mailing Address
City
State
Zip code
Phone
Parish
D. New Type of Organization:
Individual
Corporation
LLC
Non-Profit
Partnership
LLP
Government
Other >
I affirm that the information given on this application is complete, true and correct.
Signature of Applicant:
Title:
Signature of Preparer:
Date:
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Parent category: Business