Form Cr-108 - Notice Of Business Closure

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FOR OFFICE USE ONLY
KANSAS DEPARTMENT OF REVENUE
Customer Relations
_________________
Inactive:
Topeka, Kansas 66625-9000
Date/Initial
Phone: (785) 368-8222
Audited:
_________________
Fax: (785) 296-2073
Date/Initial
Deleted:
_________________
NOTICE OF BUSINESS CLOSURE
Date/Initial
(
)
1.
2.
3.
Kansas Tax Account No.
Federal Employer's ID No.
Business Phone No.
4.
5.
Business Name
Business Address
(
)
6.
7.
8.
Owner's/Officer's Name
Current Address
Telephone Number
9. On
,
this business was closed and I wish to cancel my registration for the following tax(es). Check
each box that applies and enter the specific account number for that tax.
†
†
Retailers' Sales
Bingo Enforcement
†
†
Retailers' Compensating
Dry Cleaning Surcharge
†
†
Liquor Enforcement
Withholding
†
†
Liquor Excise
Transient Guest Tax
†
†
Consumer's Use
Vehicle Rental Tax
†
†
Tire Excise
Water Protection Fee
�
�
10. Does this business currently have employees?
Yes
No
If no, enter effective date:
�
�
11. Has there been a transfer or a change in ownership?
No
Yes
If yes, complete lines a, b and c:
a. Trade name of new business
b. New owner's name
c. Starting date of new business
Taxpayer ID No.
†
†
†
†
†
12. This business has
a cash bond
an escrow bond
a surety bond
no bond
unknown
†
†
13. Have all applicable forms for the taxes checked above been filed up to date of closing?
Yes
No If no, all must be filed with this form.
†
†
14. If this is a consolidated registration, are all locations being closed?
Yes
No
If no, list the specific locations to be closed under
"Remarks" on line 15.
15. Remarks and final settlement or arrangement for settlement:
SIGN
·
HERE
Signature of Retailer/Employer
Title
Date
Signature of Preparer
FOR OFFICE USE ONLY
†
†
Was the date that the business was discontinued estimated?
No
Yes
If yes, give source of information:
†
†
Accounts receivable remain to be collected:
No
Yes
If yes, tax type:
Mailing address:
†
†
A Jeopardy Assessment is recommended.
No
Yes
If yes, tax type:
†
†
A warrant is recommended.
No
Yes
If yes, tax type:
Comments:
Prepared by:
Date:
CR-108 (Rev. 8/12)

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