Form As 2914.1 A - Application For Change To The Information Of Merchant'S Principal Office - 2010
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Form AS 2914.1 A
APPLICATION FOR CHANGE TO THE INFORMATION
Rev. Nov 30 10
OF MERCHANT'S PRINCIPAL OFFICE
The use of this form will not generate a new Registration Certificate or a change to an existing Certificate. Refer to
Form AS 2914.1 B (Application for Amendment to the Merchant's Registration Certificate of a Commercial Location).
PART I – INFORMATION OF MERCHANT’S PRINCIPAL OFFICE
Receipt Stamp
Indicate if you have any change regarding the merchant’s principal office:
Yes
No.
(If you answered “Yes”, indicate the new information in the corresponding lines. You may leave blank the lines
that are not subject to changes. If you answered “No”, continue in Part II)
1. Indicate the first seven digits of merchant's registration number:
0 0 0 0
2. Legal name of the corporation, partnership, individual owner (name, initial, last name) or other
3. Social security or employer identification number
4.Telephone
Ext.
5. E-mail address
6. Postal address
(Post Office Box, Urbanization or Building, Number or Apartment, Street)
Municipality / City
Zip Code
Country
State
7. Physical address
(Urbanization or Building, Number or Apartment, Street)
Municipality / City
Zip Code
Country
State
8. Type of organization:
Individual
Estate or Trust
Corporation or Partnership
9. Date of incorporation or creation:
Month
Day
Month
Year
Day
10. Closing date of your accounting period:
PART II – PERSONS HAVING INTEREST IN THE BUSINESS
11. Indicate if you have any change regarding the persons owning 50% or more interest in the business?
Yes
No. (If you answered “Yes”, indicate
the new information in the corresponding boxes. If you answered "No", continue with the Oath)
11a. Name
Ownership
percentage
Social security or employer
Title
identification number
If your business provides services, do you own 50% or more interest in another business?
Yes
No. If “Yes”, indicate the following information for the other business:
Name
Social security or employer identification number
Ownership
11b. Name
percentage
Title
Social security or employer
identification number
If your business provides services, do you own 50% or more interest in another business?
Yes
No. If “Yes”, indicate the following information for the other business:
Name
Social security or employer identification number
Retention: Six (6) years.
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