This form contains 45 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Contact Information
Signer's telephone. Enter 10 digit phone number Text
Enter your 10-digit telephone number. This is the phone number of the person signing the form.
New Address
New additional information (see instructions) Text
Enter any additional information related to your new address. Refer to the instructions for specific details.
New street address (number and street) or Post Office box. If a Post Office box, see instructions Text
Enter your new street address or Post Office box. If using a Post Office box, refer to the instructions.
Apartment number/Suite number Text
Enter the apartment or suite number for your new address.
P M B/private mailbox Text
Enter the private mailbox (PMB) number for your new address, if applicable.
City (If you have a foreign address, see instructions.) Text
Enter the city for your new address. If you have a foreign address, refer to the instructions.
State. Enter two letter abbreviation Text
Enter the two-letter abbreviation for the state of your new address.
Max length: 2 characters
Zip code. Enter the first 5 digits - last 4 digits Text
Enter the zip code for your new address. Use the format: first 5 digits - last 4 digits.
Max length: 10 characters
Foreign country name Text
Enter the name of the foreign country for your new address, if applicable.
Foreign province/state/county Text
Enter the province, state, or county for your new foreign address, if applicable.
Foreign postal code Text
Enter the postal code for your new foreign address, if applicable.
Old Address Information
Old additional information (see instructions) Text
Enter any additional information related to your old address as specified in the instructions.
Old street address (number and street) or Post Office box. If a Post Office box, see instructions Text
Enter your old street address, including the number and street name, or your Post Office box. Refer to the instructions if using a Post Office box.
Apartment number/Suite number Text
Enter the apartment or suite number of your old address, if applicable.
P M B/private mailbox Text
Enter the private mailbox (PMB) number of your old address, if applicable.
City (If you have a foreign address, see instructions.) Text
Enter the city of your old address. If you have a foreign address, refer to the instructions.
State. Enter two letter abbreviation Text
Enter the two-letter abbreviation for the state of your old address.
Max length: 2 characters
Zip code. Enter the first 5 digits - last 4 digits Text
Enter the zip code of your old address. This should include the first 5 digits and, if applicable, the last 4 digits.
Max length: 10 characters
Foreign country name Text
Enter the name of the foreign country for your old address, if applicable.
Foreign province/state/county Text
Enter the province, state, or county of your old foreign address, if applicable.
Foreign postal code Text
Enter the postal code of your old foreign address, if applicable.
Personal Information
Your first name Text
Enter your first name as it appears on your tax records.
Initial Text
Enter the initial of your middle name, if applicable. Maximum length is 1 character.
Max length: 1 characters
Last name Text
Enter your last name as it appears on your tax records.
Suffix Text
Enter any suffix associated with your name (e.g., Jr., Sr., III). Maximum length is 4 characters.
Max length: 4 characters
Your Social security number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). This should be 9 digits long.
Your prior name Text
Enter your prior name if it has changed since your last tax filing.
Residency Status
If your last tax return was a joint return and you are now establishing a separate residence, check the box CheckBox
Check this box if your last tax return was filed jointly with your spouse or registered domestic partner (RDP) and you are now establishing a separate residence.
Signature
Signature date. Enter date as 2 digit month / 2 digit day / four digit year Text
Enter the date of your signature in the format: 2 digit month / 2 digit day / four digit year.
Spouse/Partner Information
Spouse's / Registered Domestic Partner’s first name Text
Enter the first name of your spouse or registered domestic partner.
Initial Text
Enter the initial of your spouse's or registered domestic partner's middle name, if applicable. Maximum length is 1 character.
Max length: 1 characters
Last name Text
Enter the last name of your spouse or registered domestic partner.
Suffix Text
Enter any suffix associated with your spouse's or registered domestic partner's name (e.g., Jr., Sr., III). Maximum length is 4 characters.
Max length: 4 characters
Spouse’s / Registered Domestic Partner’s social security number or Individual Taxpayer Identification number. Enter 9 digits Text
Enter the Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) of your spouse or registered domestic partner. This should be 9 digits long.
Spouse's / Registered Domestic Partner's Prior name Text
Enter the prior name of your spouse or registered domestic partner if it has changed since their last tax filing.
Spouse/RDP Old Address
Spouse’s/Registered Domestic Partner’s old additional information (see instructions) Text
Enter any additional information related to the old address of your spouse or registered domestic partner. Refer to the instructions for specific details.
Spouse’s/Registered Domestic Partner’s old street address (number and street) or Post Office box. If a Post Office box, see instructions Text
Enter the old street address or Post Office box of your spouse or registered domestic partner. If using a Post Office box, refer to the instructions.
Apartment number/Suite number Text
Enter the apartment or suite number for the old address.
P M B/private mailbox Text
Enter the private mailbox (PMB) number for the old address, if applicable.
City (If you have a foreign address, see instructions.) Text
Enter the city for the old address. If you have a foreign address, refer to the instructions.
State. Enter two letter abbreviation Text
Enter the two-letter abbreviation for the state of the old address.
Max length: 2 characters
Zip code. Enter the first 5 digits - last 4 digits Text
Enter the zip code for the old address. Use the format: first 5 digits - last 4 digits.
Max length: 10 characters
Foreign country name Text
Enter the name of the foreign country for the old address, if applicable.
Foreign province/state/county Text
Enter the province, state, or county for the old foreign address, if applicable.
Foreign postal code Text
Enter the postal code for the old foreign address, if applicable.