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Request For Change Of Registration Information

This form is to change business registration information with the New Jersey Division of Revenue. The form provided here is simply a sample of what the actual form looks like.

STATE OF NEW JERSEY
DIVISION OF REVENUE

REG-C-L

MAIL TO:
PO BOX 252
TRENTON, N.J.
08646-0252

REQUEST FOR CHANGE OF REGISTRATION INFORMATION

This form is to be used to report any change in filing status, business activity or to change your identification information such as identification number, business and/or trade name, business address, mailing address, etc. DO NOT use this form for a change in ownership or an incorporation of a business. A NJ-REG must be completed for these changes.

A. CURRENT INFORMATION (must be completed to process this form)

FEIN # ____________________________________________

Name ____________________________________________

Address ____________________________________________

B. CHANGES TO IDENTIFICATION INFORMATION

FEIN ________________________________________

Reason for change of FEIN ________________________________________

Business Name ________________________________________
(Corporations authorized by the NJ State Treasurer must file a corporate name change amendment, pg. 22)

Trade Name ________________________________________

Business Location: (Do not use P. O. Box for location address)

Street ___________________________________________

City ____________________________________

State ________________________________________

Zip Code ________________________________________

Mailing Name and Address

Name ____________________________________________________

Street ____________________________________________________

City_______________________________________

State ________________________________________

Zip Code ________________________________________

C. Telephone Numbers:

Contact Person ____________________________________________

Title __________________________________

Daytime (_____) __________ - __________________

Evening (_____ )__________ - __________________

D. IF SEASONAL, CIRCLE MONTHS BUSINESS WILL BE OPEN:

JAN FEB MAR

APR MAY JUN

JUL AUG SEPT

OCT NOV DEC

E. CHANGES IN OWNERSHIP OR CORPORATE OFFICERS

NAME

Last Name ________________________________________

First ________________________________________

MI ________________________________________

SOCIAL SECURITY NUMBER ________________________________________

TITLE ________________________________________

HOME ADDRESS

Street ________________________________________

City ________________________________________

State ________________________________________

Zip ________________________________________


NAME

Last Name ________________________________________

First ________________________________________

MI ________________________________________

SOCIAL SECURITY NUMBER ________________________________________

TITLE ________________________________________

HOME ADDRESS

Street ________________________________________

City ________________________________________

State ________________________________________

Zip ________________________________________


F. CHANGES IN FILING STATUS AND BUSINESS ACTIVITY

Proprietorship/Partnership

____ Business Sold or Discontinued __________________________ (Date)

____ Business Incorporated __________________________ (Date)

____ Owner Deceased __________________________ (Date)

Corporation

____ Merged ___________________________ (Date)

____ Withdrew ___________________________ (Date)

____ Dissolved ___________________________ (Date)

Name and Address of New Owner or Survivor of Merger

__________________________________

__________________________________

Date Ceased Collecting Sales Tax _________________________

Date Ceased Paying Wages _________________________

Signature_______________________________________________________

Date________________________________________

Title ___________________________________________________________

Telephone (_____) ___________________________

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