This form contains 22 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Before you begin:
Tax-exempt organization Checkbox
Check this box if the business is a tax-exempt organization (as defined in the form instructions).
Business Identification
Business Name Text
Enter the legal name of the business as it should appear on IRS records.
Employer Identification Number (EIN) Number
Enter the business’s Employer Identification Number.
Max length: 10 characters
Change Type (Check all that apply)
Employment, excise, income, and other business returns Checkbox
Check this box if the address/responsible party change affects your employment, excise, income, or other business tax returns (e.g., Forms 720, 940, 941, 990, 1041, 1065, 1120).
Employee plan returns Checkbox
Check this box if the change affects employee plan returns (e.g., Form 5500 or 5500-EZ).
Business location Checkbox
Check this box if the change affects your business location address.
New Business Location Address
New Business Location Address Text
Enter the new business location address, including number and street, room or suite number (if any), city or town, state, and ZIP code.
New Business Location Foreign Country Text
Enter the foreign country name for the new business location address, if the address is outside the United States. Fill only if 'New Business Location Address' is a foreign address.
Depends on: New Business Location Address
New Business Location Foreign Province/County Text
Enter the foreign province or county for the new business location address, if applicable. Fill only if 'New Business Location Address' is a foreign address.
Depends on: New Business Location Address
New Business Location Foreign Postal Code Text
Enter the foreign postal code for the new business location address, if applicable. Fill only if 'New Business Location Address' is a foreign address.
Depends on: New Business Location Address
New Mailing Address
New mailing address Text
Enter the new mailing address including number and street, room or suite number, city or town, state, and ZIP code.
Foreign country name (new mailing address) Text
If the new mailing address is outside the United States, enter the country name. Fill only if 'New mailing address' is a foreign address.
Depends on: New mailing address
Foreign province/county (new mailing address) Text
If the new mailing address is outside the United States, enter the province or county. Fill only if 'New mailing address' is a foreign address.
Depends on: New mailing address
Foreign postal code (new mailing address) Text
If the new mailing address is outside the United States, enter the foreign postal code. Fill only if 'New mailing address' is a foreign address.
Depends on: New mailing address
New Responsible Party Information
New Responsible Party Name Text
Enter the full legal name of the new responsible party for the business.
New Responsible Party Taxpayer ID (SSN/ITIN/EIN) Text
Enter the new responsible party’s taxpayer identification number, such as an SSN, ITIN, or EIN.
Max length: 11 characters
Old Mailing Address
Old mailing address Text
Enter the previous mailing address, including street number and name (or P.O. box), room or suite number (if any), city or town, state, and ZIP code.
Old address foreign country Text
If the old mailing address is outside the United States, enter the country name for the old address. Fill only if 'Old mailing address' is a foreign address.
Depends on: Old mailing address
Old address foreign province/county Text
If the old mailing address is outside the United States, enter the province or county for the old address. Fill only if 'Old mailing address' is a foreign address.
Depends on: Old mailing address
Old address foreign postal code Text
If the old mailing address is outside the United States, enter the postal code for the old address. Fill only if 'Old mailing address' is a foreign address.
Depends on: Old mailing address
Signature.
Daytime Telephone Number Text
Enter the daytime telephone number for the person to contact about this form (optional).
Signature of Owner/Officer/Representative Text
Type the signature name of the owner, officer, or authorized representative signing this form.