CHICAGO DEPARTMENT OF FINANCE
                                                                                                                                                     BCF
                BUSINESS CHANGE FORM FOR TAX PURPOSES ONLY
            (DO NOT USE THIS FORM IF YOU HOLD A CHICAGO BUSINESS LICENSE.  FOR LICENSE CHANGES, CALL 312-747-IRIS (4747))
                          Please email completed document to:  RevenueDatabase@cityofchicago.org 
  or  fax to (312)747-1890 attn: Database   or    Return to Chicago Department of Finance, Database Unit, 333 S. State Street Chicago IL 60604
I. Account Information Before Business Change

IRIS Account #                                    Site #                            Medallion #                              Date Acquired                         
  
Business Name                                                                                                  Owner Name                                                           
 
Business Address                                                                                                                            F.E.I.N.                                      
Mailing Address                                                                                                                             I.B.T.N.                                      
       
II.  Change in Business Name or Address      
New Business Name                                                                                                                                                                          
New Business Address                                                                  City                         State                     Zip Code                     
     
New Mailing Address                                                                   City                         State                     Zip Code                     

III.  Change of Responsible Person(s)
Provide the name and title of all new officers, general partners, or Limited Liability Company  managers.
(Attach separate sheets if necessary).
            Name                                                                                                      Title                                                                      
            Name                                                                                                      Title                                                                      

IV.  Change in Business Operations
Identify and explain any changes in services, products, or internal operations that may require your business to pay other
Chicago taxes.  (Attach separate sheets if necessary).If your change makes your business subject to a Chicago tax, complete
an Affidavit (For Initial Taxable Period).  If your change makes your business no longer subject to a tax, complete an Affidavit
(For Final Taxable Period).If your business ceased operations you must file all tax returns within 45 days after the close of the
business.
                                                                                                                                                                           
If your business ceased operations (out-of-business), provide date and attach supporting documents.  Date                                  
If your business ceased operations due to a change in ownership, please provide buyer’s information in Section V.  
       
V. Change in Ownership
If you sold or transferred the business or medallion named in section I above,  provide the buyer  information below and check 
Transferee.  If you purchased or acquired by transfer the business or medallion named in section I above, provide your
information below and check Transferee.  If you are the business in section I above and you are acquiring another business,
provide the information of the acquired entity and check Transferor.  Provide the date of change in ownership.  You must
contact the Department of Finance Bulk Sales Unit and complete a Bulk Sales Notification Form  45 days before the
date of sale.
Name                                                                                                                                          Phone (         )                                 
Address                                                                                                                           IRIS Account #(if known )____________
(Check one)Transferee                 Transferor                      Date of Change in ownership                                    
            
VI.  Comments
                                                                                                                                                                                                            
VII.  Owner/Officer Statement
Under penalty or perjury, I certify that I have examined this Business Change Form and it is true, correct, and complete.
Print Name                                                                                                                                              Date                                   

Signature                                                                    Title                                                         Phone (         )                                 
                                                   EMAIL Address_________________________________________
DR91 4/18/2008