Combined Registration/application/change Form
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3SECTION H: Miscellaneous Information
(see instructions, page 4)
24
Name and address of former owner:
NAME
NAME OF BUSINESS OR CORPORATION
MAILING ADDRESS
CITY
STATE
ZIP
NOTE: If tax should be remitted to the state, ATTACH CHECK TO THIS APPLICATION and indicate on check which tax you are paying.
Make check payable to: Alabama Department of Revenue
Send a SEPARATE check for each tax that you are paying.
TYPE OF TAX
TAXABLE SALES / RECEIPTS
TAX DUE
__________________________________________
$______________________________
$________________________
__________________________________________
$______________________________
$________________________
__________________________________________
$______________________________
$________________________
The Combined Registration/Application/Change Form was designed to
allow businesses the opportunity to complete one all-inclusive form that will
satisfy many needs and eliminate filing multiple forms. This is the
Department of Revenue’s initial step in simplifying registration procedures.
If you need assistance, please call (334) 242-1170 or come to our Mont-
gomery office at 50 North Ripley Street, 4th floor, room 4301.
Mail completed application and any initial tax returns to:
Alabama Department of Revenue
Central Registration Unit
P.O. Box 327100
Montgomery, AL 36132-7100
If you have questions concerning a specific tax matter, please contact the
Taxpayer Service Center nearest you.
Taxpayer Service Centers
Auburn/Opelika – 3300 Skyway Drive, Auburn (36830) Phone (334) 887-9549
Birmingham – 2024 3rd Avenue North (35203) Phone (205) 323-6387
Decatur – 1403A Beltline Road, S.W. (35601) Phone (256) 353-2932
Dothan – 344 North Oates Street (36303) Phone (334) 793-5803
Gadsden – 235 College Street (35901) Phone (256) 547-0554
Huntsville – 994 Explorer Boulevard (35806) Phone (256) 922-1082
Mobile – 857 Downtowner Blvd., Suite E (36609) Phone (334) 344-4737
Montgomery – 1021 Madison Avenue (36104) Phone (334) 242-2677
Muscle Shoals – 2909 Wilson Dam Highway (35661) Phone (256) 383-4631
Tuscaloosa – 518 19th Avenue (35401) Phone (205) 759-2571
TDD Number – (334) 242-3061
The address for the Alabama Department of Revenue Web site is
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