Form Mo 860-1108 - Change Of Name/address

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PLEASE COMPLETE ONLY THOSE LINES THAT RE-
MISSOURI DEPARTMENT OF REVENUE
QUIRE CHANGING
CHANGE OF NAME/ADDRESS
NEW NAME
PLEASE USE THIS FORM TO REPORT ANY CHANGES OF
MAILING ADDRESS AND/OR NAME.
SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S NEW NAME
__ __ __ - __ __ - __ __ __ __
__ __ __ - __ __ - __ __ __ __
PREVIOUS NAME AND MAILING ADDRESS
NEW MAILING ADDRESS
CITY
STATE
ZIP CODE
MAIL TO:
Missouri Department of Revenue
P.O. Box 555
Jefferson City, MO 65105-0555
MO 860-1108 (11-2008)

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