Business Change Form For Tax Purposes Only Form

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CHICAGO DEPARTMENT OF REVENUE
BCF
BUSINESS CHANGE FORM FOR TAX PURPOSES ONLY
(DO NOT USE THIS FORM IF YOU HOLD A CHICAGO BUSINESS LICENSE)
I. Current Account Information
Account Number
Site #
Medallion #
Date Acquired
Business Name
Owner Name
Business Address
F.E.I.N.
Mailing Address
I.B.T.N.
II. Change in Business Name or Address
New Business Name
New Business Address
City
State
Zip Code
New Mailing Address
City
State
Zip Code
III. Change of Responsible Person(s)
Provide the name and title of all new officers, general partners, or Limited Liability Company managers.
(Attach separate sheets if necessary).
Name
Title
Name
Title
IV. Change in Business Operations
Identify and explain any changes in services, products, or internal operations that may require your business to pay other
Chicago taxes. (Attach separate sheets if necessary).
If your business ceased operations, (out-of-business), provide date and attach supporting documents. Date
V. Change in Ownership
If you purchased, sold, transferred, or acquired by transfer the business or medallion named in section 1 above, identify the
seller, buyer, transferee, or transferor and provide the date of change in ownership.
Seller
Buyer
Transferee
Transferor
Date
Name
Phone (
)
Address
VI. Comments
VII. Owner/Officer Statement
Under penalty or perjury, I certify that I have examined this Business Change Form and it is true, correct, and complete.
Print Name
Date
Signature
Title
Phone (
)
DR91 12/96

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