Form 941/c1c-Me - Name And Address Change Form - 2004

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THIS BOOK CONTAINS FORMS NEEDED TO FILE AND PAY MAINE INCOME TAX
WITHHOLDING FOR NONRESIDENT PARTNERS, SHAREHOLDERS & BENEFICIARIES
2004
Withholding Account Number:
Tax Year:
This book contains passthrough withholding tax returns, including income tax withholding listing (FORM 941P-ME) and withholding amended returns (Form 941A-ME).
PLEASE CHECK THESE DOCUMENTS FOR ACCURACY AND COMPLETENESS.
REPORT ANY ERROR by writing to:
MAINE REVENUE SERVICES
P.O. Box 9118
Augusta, ME 04332-9118
OR by calling:
For Registration Problems
207-287-2338
For Billing Problems
207-626-8475
DO NOT REMOVE THE UPPER SECTION OF THIS PAGE. IT SHOULD REMAIN IN THIS BOOKLET FOR REFERENCE PURPOSES.
NAME AND ADDRESS CHANGE FORM
FORM 941/C1C-ME
If you have a change in your name, address and/or phone number, complete this form and mail it to: MAINE REVENUE SERVICES.
If your Federal Employer Identification Number changes, call Central Registration at 207-287-2338.
Note: If your business is discontinued, complete the cancellation notice at the bottom of the quarterly return.
Mail to:
Present Pass-through Withholding Account Number:
Maine Revenue Services
P.O. Box 9118
Augusta, ME 04332-9118
Present Name and Address:
New Name and Address (If Applicable):
Old Phone Number:
New Phone Number (If Applicable):
Effective Date of Change:
Remarks:
Date
Signature
Title
Telephone
5

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