Fillable Form 22 - Nebraska Change Request (Page 2 of 2) in pdf

INSTRUCTIONS

WHO MUST FILE. A Form 22 should be filed by any taxpayer who:

•

Has a name or address change;

•

Needs to correct, cancel, reinstate, or change a Nebraska tax certificate, license, or permit; or

•

Needs to change the filing frequency for sales and use tax, tire fee, lodging tax, or income tax withholding returns.

One request may be used to correct, cancel, or change more than one certificate, license, or permit held by the taxpayer for the

tax programs listed, provided the Nebraska ID number is the same.

Form 22A

should be used for individual income tax name

and address changes.

WHEN AND WHERE TO FILE. Mail to the Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903, or

fax to 402-471-5927, prior to the change.

PERMANENTLY CLOSING THE BUSINESS. Form 22 should be filed to cancel one or more of the tax programs listed in

line 5. You are required to file all tax returns for tax periods through the date of your last transaction, or the last wage payment

made by the date entered on line 6.

Employers who cancel their income tax withholding account should, within 30 days after discontinuing business, file a final

Nebraska Reconciliation of Income Tax Withheld, Form

W-3N, and attach the state copy of each

Wage and Tax Statement,

Federal Form

W-2, issued to each employee.

SPECIFIC INSTRUCTIONS

LINE 1. Enter the Nebraska ID number which you hold or have previously held. Do not enter your Social Security number.

LINE 2. Enter your federal employer ID number, if you hold one. If one has been applied for, enter “Applied For.” If no federal

employer ID number is held or has been applied for, enter your Social Security number.

LINE 3. Enter the Nebraska county where your business is located.

NAME AND ADDRESS. Enter the name and address as last filed with the Nebraska Department of Revenue (Department) or

which is printed on your present certificate, license, or permit. A new name and address should be entered in the area immediately

following line 9 of this request.

LINE 5. Check the tax programs affected by this request. If there is a change in more than one program, check all

appropriate boxes.

LINE 6. A taxpayer closing a business must request cancellation of the tax program. A taxpayer having a seasonal type of

business may request cancellation of the tax program for the period in which no business activity is conducted. Returns must

be filed for all periods ending prior to the date of cancellation.

A change in ownership or type of ownership will require a new certificate, license, or permit. When possible, the

Nebraska Tax Application, Form

20, used to obtain a new certificate, license, or permit, should accompany or precede

this request for cancellation.

LINE 7. A taxpayer who previously cancelled a tax program may have it reinstated provided no change in the business has

occurred which would require a new certificate, license, or permit.

LINE 8. A taxpayer filing a sales tax, use tax, or tire fee return with a tax liability of $900 to $3,000 annually may request

a quarterly filing frequency. Those with a tax liability of less than $900 annually may request an annual filing frequency.

Taxpayers filing a lodging tax return and remitting $99 or less of tax annually may request to file an annual return. Employers

withholding less than $500 annually in state income tax may request to file an annual return, rather than quarterly returns.

Changes in filing frequency are not effective until approval has been received from the Department. The taxpayer must complete

and file all preidentified returns received for periods prior to the approval.

LINE 9. Enter the new name and address. The location address box cannot contain a PO Box Number; it must show the street

address. If the taxpayer wants a return to be mailed to a preparer or another person, the name and mailing address should be

completed to show this change.

LINE 11. Give a detailed explanation of the reason for this request. If there has been a change in ownership, give the name and

address of the new owner.

SIGNATURE. This request must be signed by the owner, partner, member, corporate officer, or other individual authorized to

sign by a

power of attorney

on file with the Department.

FOR NEBRASKA DEPARTMENT OF REVENUE USE ONLY

Check the forms below that were sent or received (Tax Year = TY Tax Period = TP)

Forms sent with Form 22.

Form 10, TP ______________

Form 941N, TP ______________

Form W-3N, TY ______________

Other _______________________________________________________________________ Initials ______ Date ________________

Forms received with Form 22.

Form 10, TP ______________

Form 941N, TP ______________

Form W-3N, TY ______________

Other ________________________________________________________________________________________________________

Form 22 - Nebraska Change Request Page 2

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