Form Bt-115-C-W - Notification Of Business Address Change

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Oklahoma Tax Commission
Form BT-115-C-W
Revised 5-2012
Notification of Business Address Change
I. Information
Name of Permit Holder: ____________________________________________________ FEIN/SSN:_______________________
Trade Name/DBA of Business: ______________________________________________ Store Number: ____________________
Mailing Address: __________________________________________________________________________________________
City: _____________________________________________________ State: ________ Zip Code: _______________________
Business Telephone Number: ___________________________
Daytime Telephone Number: ___________________________
Tax types for which the new address is applicable: (provide the permit or account number for each)
II. Tax Types
Sales: __________________ Use: ___________________ Cigarette: ___________________ Tobacco: __________________
Beer*: _______________________ Mixed Beverage**: _______________________ Withholding: _______________________
Waste Tire: ___________________ Franchise: ___________________ Other: _______________________________________
Your cigarette license, beer license, sales tax permit and mixed beverage license are transferable to your new business location
without an additional fee subject to the limitation stated below.
a.
* Beer License. You must obtain a new county beer license or obtain an amended county license from the county clerk for
the new location (A copy must be attached to the application) before the permit can be transferred to the new location.
b. ** Mixed Beverage. You must obtain permission from the ABLE Commission to change the location for your mixed beverage
permit. Upon approval from the ABLE Commission, we will process the transfer of your permit.
III. Business Information
office use only
COPO:
Is this a change of mailing address?
Yes
No
Is this a change of physical location?
Yes
No
A) New Mailing Address of Business:
Street Address: _________________________________________________________
Effective Date: ___________________
City: _____________________________________________________ State: ________ Zip Code: _______________________
B) Previous Location of Business:
Street Address:
_____________________________________________________________
(do not use PO Box or rural route number)
City: _____________________________________________________ State: ________ Zip Code: _______________________
County: __________________________________________________
C) New Location of Business:
Street Address:
_____________________________________________________________
(do not use PO Box or rural route number)
City: _____________________________________________________ State: ________ Zip Code: _______________________
County: _______________________________________________________________
D) New Location Information:
Check here if in City Limits:
Effective Date of New Location: __________________________________
Are all the sales and/or deliveries made inside the city limits of the city listed above?
Yes
No
Are all the sales and/or deliveries made inside the county limits of the county listed above?
Yes
No
I declare that the information contained in this application and any attachment is true and correct to the best of my knowledge.
iv. Signature
Mail To:
Authorized Signature: ____________________________________________________
Oklahoma Tax Commission
Post Office Box 26920
Title: ________________________________________ Date: ____________________
Oklahoma City, OK 73126-0920

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