Form Do-5 - Name Or Address Change Form
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1Division of Taxation
Phone: 785-368-8222
915 SW Harrison St
Fax: 785-296-2073
Topeka, KS 66612-1588
Nick Jordan, Secretary
Department of Revenue
Sam Brownback, Governor
Steve Stotts, Director of Taxation
Name or Address Change Form
Individual
Current Name:
Current SSN:
❏
I am changing my name.
Name return was filed under
❏
I am changing my address.
Old Email Address
Social Security Number
Contact me by Home Phone Number
Current Email Address
Spouse’s Social Security Number
Contact me by Cell Phone Number
(if applicable)
New Name (include spouse’s name if filed jointly)
New Address (street, city, state, and zip code)
Signature
Date
Business
Current Business Name:
Current EIN/SSN:
❏
I am changing my business name: New name
❏
❏
❏
I am changing my address:
Business
Business Mailing Address
Location Address
❏
❏
❏
I am correcting my EIN.
Old EIN ________________________
New EIN ____________________________
❏
This change will affect the following tax accounts:
❏
❏
❏
Retailers’ Sales Tax
Dry Cleaning Surcharge
Tire Excise Tax
❏
❏
❏
Withholding Tax
Liquor Drink Tax
Transient Guest Tax
❏
❏
❏
Consumers’ Compensating Use Tax
Liquor Enforcement Tax
Vehicle Rental Excise Tax
❏
❏
❏
Retailers’ Compensating Use Tax
Nonresident Contractor
Water Protection/Clean Drinking Water Fee
❏
❏
Cigarette Vending Machine Permit
Privilege Tax
❏
❏
Corporate Income Tax
Retail Cigarette License
MAILING ADDRESS
(please provide EIN above)
New Mailing Address (street, county, city, state, and zip code)
Contact me by Home Phone Number
Old Email Address
Current Email Address
Contact me by Cell Phone Number
LOCATION ADDRESS
Effective Date
(please provide EIN above)
❏
Old Location Address (street, county, city, state, and zip code)
Outside city limits
❏
Inside city limits
❏
New Location Address (street, county, city, state, and zip code)
Outside city limits
❏
Inside city limits
Old Email Address
Contact me by Home Phone Number
Current Email Address
Contact me by Cell Phone Number
Signature
Date
Mail to: Kansas Department of Revenue, Correspondence, 915 SW Harrison St., Topeka, KS 66612-1588
DO-5
(Rev. 6/13)
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Parent category: Financial