CHANGE OF ADDRESS
NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
SFN 60488 (10-2013)
You may use this Change of Address form to notify the Office of State Tax Commissioner of an address
change. Each taxpayer will need their own form. Check the box for each account type to which the address
change should be applied.
Telephone Number
Date Requested
Email Address
Individual/Business Name
Social Security Number/Federal Employer Identification Number
Check all that apply
Corporation
Spouse SSN (if filing jointly) _____________________
Individual
S Corpporation
Sales/Use Permit # _____________________
Partnership
Withholding
Other _____________________
Fiduciary
Royalty Withholding
Old Mailing Address (Street, or PO Box)
State
ZIP Code
City
New Mailing Address (Street, or PO Box)
State
ZIP Code
City
New Location Address (if different from mailing address)
State
ZIP Code
City
This form must be signed by the taxpayer or a representative of the taxpayer making the request for the address change. A representative
is a person who has valid power of attorney to handle tax matters or is otherwise authorized to sign tax returns for the taxpayer. If you are
a representative signing for the taxpayer, also attach a copy of your power of attorney.
I declare under the penalties of North Dakota Century Code ch. 12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a
governmental matter, that this application, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge
and belief is a true, correct and complete application.
Print Name
Title
Date
Signature (authorized individual)
Comments
PRIVACY ACT NOTIFICATION
In compliance with the Privacy Act of 1974, disclosure of a social security number or Federal Employer Identification Number (FEIN) on this
form is required under N.D.C.C. §§ 57-01-15, 57-38-31, 57-38-32, 57-38-42, 57-38-60, 57-39.2.11, and 57-40.2-07, and will be used for tax
reporting, identification, and administration of North Dakota tax laws. Disclosure is mandatory. Failure to provide the social security number or
FEIN may delay or prevent the processing of this form.
Send completed form to:
Office of State Tax Commissioner
Business Registration
Fax: 701.328.0332
600 E. Boulevard Ave., Dept. 127
E-mail: taxregistration@nd.gov
Bismarck, ND 58505-0599