Sales & Use Tax Account Update Form

State of Wyoming

D

R

EPARTMENT OF

EVENUE

, Governor

122 West 25th Street, 2-West, Cheyenne, Wyoming 82002-0110

M

H. M

ATTHEW

EAD

, Director

Telephone: 307- 777-7961 ○ Web:

D

W. N

ANIEL

OBLE

Administration Fax (307)777-7722 ○ Property Tax Division Fax (307)777-7527 ○ Excise Division Fax (307)777-3632 ○ Mineral Division Fax (307)777-7849 ○ Liquor Division Fax (307)777-6255

Sales & Use Tax Account Update Form -

Please print, using dark blue or black ink

Add or Update

Name, Title

Authorized Contact

Phone, Email, Fax

Update Mailing

Street; Suite, unit or apartment

Address

City, State, Zip+4

Update Location

Street; Suite, unit or apartment

Address

City, State, Zip+4

If you change your location to a different county in WY, you will need a new license

Update Ownership or

Please indicate if changing Doing Business As (DBA) name or ownership name

DBA Name

Change Business

IE Started as contract pumper, now a florist

Description

Cancel License

Provide closure date

Other

I,

in my capacity as

for

Printed Name

Title or job description

, which has RID #

and is associated with

Name of Business

Revenue Identification #

Lic #

, attest that I am authorized to make changes to this account.

License number, if applicable

Signature, Phone Number

Date

Excise Tax Division

Sales/Use Tax Account Update Form

Eff 07/01/2013

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