Form Reg-C - Taxpayer'S Request For Change Of Tax Information
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1MAIL TO:
REG-C
STATE OF NEW JERSEY - DIVISION OF TAXATION
PO Box 252
(12-96)
TRENTON, N.J.
TAXPAYER’S REQUEST FOR CHANGE OF TAX INFORMATION
08646-0252
This form is to be used to report any change in filing status, business activity or to change your identification information such as
identification number, name, business address, mailing address, etc. DO NOT use this form for a change in ownership or an incorporation
of a business. A REG-1 must be completed for these changes.
A.
CURRENT INFORMATION (must be completed to process this form)
Federal ID # _____________________________________ or Soc. Sec. # of Owner ____________________________________
Name ___________________________________________________________________________________________________
Address _________________________________________________________________________________________________
B
CHANGES TO IDENTIFICATION INFORMATION
Federal Identification Number
-
Name ___________________________________________________________________________________________________
(IF INCORPORATED, give Corp. name; if not give last name, first name, MI of owner, partners)
Trade Name ______________________________________________________________________________________________
Mailing Name and Address - (if different from business address)
Business Location: (Do not use P. O. Box for location address)
Name _______________________________________________
Street ____________________________________________
Street _______________________________________________
City _______________________________ State
City___________________________________State
Zip Code
-
Zip Code
-
(Give 9-digit Zip)
(See instructions in REG-1A for providing alternate addresses)
(Give 9-digit Zip)
Signature_______________________________________________________
Date________________________________________
Title ___________________________________________________________
Telephone (
) ___________________________
C.
Telephone Numbers: Contact Person ______________________________________ Title ______________________________
Daytime: (
) ________ - ______________ Ext.____________
Evening: (
)________ - ______________ Ext.____________
D
.
IF SEASONAL, CIRCLE MONTHS BUSINESS WILL BE OPEN:
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
E.
CHANGES IN OWNERSHIP OR CORPORATE OFFICERS
NAME
SOCIAL SECURITY NUMBER
HOME ADDRESS
(Last Name, First, MI)
TITLE
(Street, City, State, Zip)
F.
CHANGES IN FILING STATUS AND BUSINESS ACTIVITY
Proprietorship/Partnership
Date
Corporation
Date
¨ Business Sold or Discontinued
¨ Merged
_______________________
________________________
¨ Business Incorporated
¨ Withdrew
_______________________
________________________
¨ Owner Deceased
¨ Dissolved
_______________________
________________________
Name and Address of New Owner or Survivor of Merger ________________________________________________________
Date Ceased Collecting Sales Tax
_______________________
Date Ceased Paying Wages
_______________________
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Parent category: Financial