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 (_____) ___________________________