Taxpayer Change Of Address - Massachusetts Department Of Revenue

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Rev. 2/96
MASSACHUSETTS DEPARTMENT OF REVENUE
Taxpayer Change of Address
Name ________________________________ SS. No. _____________________________
Name of Spouse ________________________ SS. No. _____________________________
Old Address ________________________________________________________________
__________________________________________________________________________
New Address _______________________________________________________________
__________________________________________________________________________
Type of Return Filed:
Form 1
Telefile
Form 3
Form 1-NR/PY
Form 2
Other _________________________
Signature: ____________________________________ Date: ________________________
Send to: Massachusetts Department of Revenue, P.O. Box 7011, Boston, MA 02204.

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