Form 4732 - Cigarette / Other Tobacco Products Registration Change Request

Download a blank fillable Form 4732 - Cigarette / Other Tobacco Products Registration Change Request in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 4732 - Cigarette / Other Tobacco Products Registration Change Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

Print Form

MISSOURI DEPARTMENT OF REVENUE

TAXATION DIVISION

FORM

• PLEASE USE THIS FORM TO MAKE CHANGES IN

4732

P.O. BOX 811, JEFFERSON CITY, MO 65105-0811

YOUR REGISTRATION RECORDS

CIGARETTE / OTHER TOBACCO PRODUCTS

• PLEASE PRINT OR TYPE

(REV. 03-2012)

REGISTRATION CHANGE REQUEST

MISSOURI CIGARETTE/OTHER

BUSINESS NAME CURRENTLY ON FILE

TOBACCO PRODUCTS TAX ID NO.

BUSINESS ADDRESS CURRENTLY ON FILE

PLEASE MAKE THE FOLLOWING CHANGE(S) IN MY REGISTRATION RECORDS: (CHECK AND COMPLETE APPROPRIATE ITEMS)

CHANGE BUSINESS NAME TO:

NAME

D/B/A

CHANGE FEDERAL IDENTIFICATION NUMBER TO:

CHANGE TYPE OF OWNERSHIP TO:

SOLE OWNER

PARTNERSHIP

GOVERNMENT

OTHER

MISSOURI CERTIFICATE OF AUTHORITY NUMBER

MISSOURI CORPORATION

CORPORATION

MISSOURI FICTITIOUS NAME NUMBER

FEIN NUMBER

FICTITIOUS NAME BUSINESSES:

CHANGE OWNER NAME TO: (USE ONLY IF CHANGE RESULTS FROM CHANGE IN TYPE OF OWNERSHIP. IF OWNER

NAME CHANGES DUE TO TRANSFER OR SALE, ETC., A NEW APPLICATION MUST BE COMPLETED)

NEW LEGAL NAME OF OWNER

CURRENT PHONE NUMBER

(__ __ __) __ __ __ - __ __ __ __

OWNER SOCIAL SECURITY NUMBER

BIRTHDATE (MMDDCCYY)

–

IF SOLE PROPRIETOR:

CHANGE OF PARTNERS IN A CORPORATION:

(ATTACH SUPPLEMENTAL LIST OF DELETIONS AND ADDITIONS, IF NECESSARY)

DELETE:

NAME (LAST, FIRST, MIDDLE INITIAL)

TITLE

SOCIAL SECURITY NUMBER

BIRTHDATE (MMDDCCYY)

STREET ADDRESS

CITY

STATE

ZIP CODE

ADD:

NAME (LAST, FIRST, MIDDLE INITIAL)

TITLE

SOCIAL SECURITY NUMBER

BIRTHDATE (MMDDCCYY)

STREET ADDRESS

CITY

STATE

ZIP CODE

CHANGE PHYSICAL LOCATION TO:

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

CHANGE ADDRESS WHERE REPORTING FORMS ARE TO BE MAILED:

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

CHANGE ADDRESS WHERE BOOKS AND RECORDS ARE KEPT:

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

ATTACH ORIGINAL RIDER FROM BONDING COMPANY COVERING CHANGE OF NAME AND/OR ADDRESS

10.

A NEW BOND INDICATING CHANGE OF OWNERSHIP ACCOMPANIED BY NEW APPLICATION

OWNER OR AUTHORIZED PERSON

TITLE

DATE

__ __ / __ __ / __ __ __ __

If you have questions or need assistance in completing this form, please call (573) 751-7163 or e-mail excise@dor.mo.gov. You may also access the Department’s

web site at TDD: (800) 735-2966

DOR-4732 (03-2012)