Form Ex-012a - Local Exposition Tax Return For Annual Filers - Wisconsin Department Of Revenue Page 2

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Taxpayer Information Changes
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EX-012A (R. 8-12)
Page 2 of 2
Business Discontinued Date:
MM
DD
YYYY
Please indicate reason for discontinuation:
Deceased
Merger with
Partner added
Formed LLC
Business did not materialize
Partner dropped
Incorporated
No taxable activity
Sold to
Other
(please explain)
Mailing Address Change
Street Address or PO Box
City
State
Zip code
Business Location Change
Street Address
City
State
Zip code
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