Form Dr 1102 - Account Change Or Closure Form
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1ACCOUNT CHANGE OR CLOSURE FORM
DR 1102 (11/99)
ACCOUNT CLOSURE ONLY / DATE ACCOUNT CLOSED:
Sales Tax _____________
Entire Account _________
Withholding Tax ________
ACCOUNT NO.
F.E.I.N.
ADDRESS CHANGE ONLY
PREVIOUS NAME AND ADDRESS
NEW NAME AND ADDRESS
Name
Address
City
State
ZIP
Telephone Number
Mailing Address
Physical Location
Both
MAIL TO: COLORADO DEPARTMENT OF REVENUE
Authorized Signature
DENVER, COLORADO 80261-0013
Note: If your retail business location changes during a filing period you must file a separate sales tax return for
the taxes collected at each location.
'00 retail sales coupon bk
3
1/17/01, 9:57 AM
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Parent category: Financial