Form 163 - Notice Of Change Or Discontinuance

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Michigan Department of Treasury

Account Number (FEIN or TR Number)

163 (Rev. 08-12)

Notice of Change or Discontinuance

Check this box if you have not received

a current set of SUW forms.

Use this form only if you discontinued or made changes to your business. Complete all sections that apply.

PART 1: BUSINESS INFORMATION

Taxpayer’s Business Name and Legal Address

Taxpayer’s Business Name and Mailing Address

Change our Business Name and/or Legal Address To:

Change our Business Name and/or Mailing Address To:

(If P.O. Box Number, you must include a street address)

PART 2: DISCONTINUE BUSINESS

YOU MUST SIGN THIS FORM.

Discontinue All Business Tax Types - Effective Date:

PART 3: CHANGE TAX TYPE

Effective Date:

Applicable tax types checked in Part 3 will be removed from your business registration effective this date.

Check the appropriate boxes to add or delete a tax or license from your registration (check all that apply).

ADD DEL

Sales Tax

Corporate Income Tax

Flow-Through Withholding Tax

Motor Fuel Tax License

Use Tax

Michigan Business Tax

Payroll/Pension Withholding Tax**

IFTA Licenses

** To add withholding, complete an Application for Registration (form 518).

Tobacco Products Tax License

PART 4: OTHER BUSINESS CHANGES OR INFORMATION

• If you are a seasonal business, enter the months your business is open: _______________________________________________________

• Enter your correct Federal Employer Identiﬁ cation Number:__________________________________________________________________

• Enter in Part 1 your contact address after the discontinuance or sale of your business.

• Date on which part or all (circle one) of the business was sold: ______________________________________________________________

• Buyer’s name and address: ___________________________________________________________________________________________

• Attach to this form additional information and any relevant documentation explaining other changes (e.g. mergers and name changes) to your business.

If this business was changed (LLC, Limited Partnership, Sole Proprietor, Corporation, or Partnership) complete an Application for Registration (form 518)

available at

Taxpayer’s Signature (Required)

Print Taxpayer’s Name and Title (Required)

Date

Complete this form and mail to:

Michigan Department of Treasury

Registration Unit

P.O. Box 30778

Lansing, MI 48909-8278