Form 3875 - Request For Revenue Sharing Change Of Address
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1Michigan Department of Treasury
Reset Form
3875 (Rev. 09-11)
Request for Revenue Sharing Change of Address
INSTRUCTIONS: Fax the completed form to (517) 335-3298 or mail to the address listed below. This form is also available on
Treasury’s Web site at for on-line fill and print. Direct questions to the Office of Revenue and Tax Analysis
by writing to the address below or calling (517) 373-2697.
GENERAL INFORMATION
Federal Identification Number
Revenue Sharing Local Unit Code
38 -
Local Unit Name
Treasurer Name
Effective Date of Address Change
County
Local Unit Type (check only one)
County
City
Village
Township
OLD ADDRESS
Mailing Address (Street, P.O. Box)
ZIP Code
City
State
NEW ADDRESS
Mailing Address (Street, P.O. Box)
ZIP Code
City
State
AUTHORIZATION (
Authorized signer must be the Treasurer or Clerk of the Local Unit of Government.)
Telephone Number
Signature
Printed or Typed Name and Title
Date
Return completed forms to:
Michigan Department of Treasury
Office of Revenue and Tax Analysis
P.O. Box 30722
Lansing, MI 48909
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Parent category: Financial