Request For Change - Delaware Division Of Revenue - 2012
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REQUEST FOR CHANGE
DELAWARE DIVISION OF REVENUE
PO BOX 8750
New Booklets Will Be Issued
0038-99
WILMINGTON, DE 19899-8750
for ID No. & Tax Year Ending Changes Only
003899090000000000000 12311200000000000000000000000000
CORRECT TAX YEAR ENDING DATE
ACCOUNT NUMBER CHANGE
EFFECTIVE DATE
REASON FOR CHANGE
1
2
3
4
ACCOUNT NUMBER
5
0-000000000-000
CORRECT BUSINESS LOCATION ADDRESS
NAME
7
OUT OF BUSINESS
OLD BUSINESS NAME AND ADDRESS
DATE
ADDRESS
CITY
STATE
ZIP CODE
6
CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE
NAME
ADDRESS
AUTHORIZED SIGNATURE
DATE
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
E-MAIL ADDRESS
(Revised 10/12/04)
2012
Corporate Income Tax
Request for Change Form
Use this form to make corrections or changes to your name, address, account number or taxable year-ending date.
Also use this Request for Change form if you have gone out of business and indicate the date your business ceased
operations.
Please Note: The Corporate Income Tax Request for Change form only makes changes to your corporate account in
our Business Master File. If you need to make similar changes to your Sub S Corporate, License and/or Withholding
accounts, please complete the Sub S Corporate Request for Change form, the License Request for Change form or the
Withholding Request for Change form respectively for each type of tax.
Step-by-Step Instructions
Step 1: Please enter your information as it appears on the Division of Revenue’s current records
Account Number – Please enter the Federal Tax Identification Number that the Delaware Division of Revenue currently
has on file for you.
Business Name and Address – Please enter the business name and location address that the Delaware Division
of Revenue currently lists as your business name and location address.
Step 2: Fill-in any fields you wish to change on the Request for Change form below
Field 1. Correct Tax Year Ending Date – Please enter your correct tax-year ending date.
Field 2. Account Number Change – If you wish to change the information in Box A, please enter your correctaccount
number in Field 2. Otherwise, leave Field 2 blank.
Field 3. Effective Date – Please enter the date you would like this Request for Change form to go into effect.
Field 4. Reason for Change – Please enter the reason for your changes (i.e. out of business, incorporated, moved).
Field 5. New Business Location Address – If you wish to change the information in Box B, please enter your
correct location address in Field 5. Otherwise, leave Field 5 blank.
Field 6. New Mailing Address – Please enter your correct business mailing address.
Field 7. Out of Business checkbox (include Date Closed) – Please check this box if your location has currently
gone out of business. Please enter the date your location stopped operations in the Date space provided.
Step 3: Sign and date the form. Mail to the address listed on the form or fax to 302-577-8203.
If you have any questions, please call the Delaware Division of Revenue Business Master File Section at 302-577-8778.
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