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
Affected Returns
Affected Returns 1: Employment, Excise, Income, and Other Business Returns Checkbox
Check this box if the change of address or responsible party affects your employment, excise, income, or other business returns (e.g., Forms 720, 940, 941, 990, 1041, 1065, 1120).
Affected Returns 2: Employee Plan Returns Checkbox
Check this box if the change of address or responsible party affects your employee plan returns (e.g., Forms 5500, 5500-EZ).
Affected Returns 3: Business Location Checkbox
Check this box if the change of address or responsible party affects your business location.
Business Identification
Business Name Text
Please enter the full legal name of the business.
Employer Identification Number Text
Please enter the Employer Identification Number (EIN) for the business.
Max length: 10 characters
New Business Location
New Business Location Address Text
Enter the new business location's street number, street, room or suite number, city or town, state, and ZIP code.
New Business Location Foreign Country Name Text
Enter the foreign country name for the new business location.
New Business Location Foreign Province/County Text
Enter the foreign province or county for the new business location.
New Business Location Foreign Postal Code Text
Enter the foreign postal code for the new business location.
New Mailing Address
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New Mailing Address Foreign Country Name Text
Enter the foreign country name for the new mailing address.
New Mailing Address Foreign Province or County Text
Enter the foreign province or county for the new mailing address.
New Mailing Address Foreign Postal Code Text
Enter the foreign postal code for the new mailing address.
New Responsible Party Information
New Responsible Party's Name Text
Enter the full name of the new responsible party.
New Responsible Party's SSN, ITIN, or EIN Text
Enter the Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN), or Employer Identification Number (EIN) of the new responsible party.
Max length: 11 characters
Old Mailing Address
Old Mailing Address Text
Enter the old mailing address, including the street number, street name, room or suite number, city or town, state, and ZIP code.
Old Foreign Country Name Text
Enter the foreign country name for the old mailing address.
Old Foreign Province or County Text
Enter the foreign province or county for the old mailing address.
Old Foreign Postal Code Text
Enter the foreign postal code for the old mailing address.
Signature and Contact
Daytime Telephone Number Text
Enter the daytime telephone number of the person to contact.
Signatory's Title Text
Enter the title of the owner, officer, or representative signing the form.
Tax-Exempt Organization Status
Tax-Exempt Organization Checkbox
Check this box if the entity is a tax-exempt organization.