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DELAWARE DIVISION OF REVENUE     REQUEST FOR CHANGE                                            New Booklets Will Be Issued
PO BOX 8750                                                                                                   for Business FEIN 
WILMINGTON, DE 19899-8750      *DF62214019999*                                                                or SSN Changes Only
                                                                  *DF62214019999*
00949909000000000000012311500000000000000000000000000
CHANGE: TAX YEAR ENDING DATE BUSINESS FEIN OR SSN                 CHANGE: BUSINESS FEIN OR SSN EFFECTIVE DATE       REASON FOR CHANGE

ACCOUNT NUMBER       0-000000000-000                              CORRECT BUSINESS LOCATION ADDRESS
                                                                  NAME
               OUT OF BUSINESS                                    ADDRESS
                                                                  CITY                                        STATE ZIP CODE
BUSINESS MAILINGADDRESS        EFFECTIVE DATE                                                                        
                                                                  CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE
                                                                  NAME
                                                                  ADDRESS
                                                                  CITY                                        STATE ZIP CODE

                                                                  TELEPHONE NUMBER
AUTHORIZED SIGNATURE                                              EMAIL ADDRESS                               DATE

                                                                         2015
                                     Sub S Corporate Tax
                                 Request for Change Form

Use this form to make corrections or changes to your name, address, account number or taxable year-ending date.
Also use this Request for Change form if you have gone out of business and indicate the date your business ceased
operations.

Please Note: The S Corporate Income Tax Request for Change form only makes changes to your S corporate account
in our Business Master File. If you need to make similar changes to your Corporate, License and/or Withholding accounts,
please complete the Corporate Request for Change form, the License Request for Change form or the Withholding Request
for Change form respectively for each type of tax.

                                 Step-by-Step Instructions

Step 1: Please enter your information as it appears on the Division of Revenue’s current records

Account Number – Please enter the Federal Tax Identification Number that the Delaware Division of Revenue currently
           has on file for you.
Business Name and Address  – Please enter the business name and location address that the Delaware Division of
           Revenue currently lists as your business name and location address.

Step 2: Fill-in any fields you wish to change on the Request for Change form below

Field 1. Correct Tax Year Ending Date – Please enter your correct tax-year ending date.
Field 2. Account Number Change – If you wish to change the information in Box A, please enter your correctaccount
           number in Field 2. Otherwise, leave Field 2 blank.
Field 3. Effective Date – Please enter the date you would like this Request for Change form to go into effect.
Field 4. Reason for Change – Please enter the reason for your changes (i.e. out of business, incorporated, moved).
Field 5. New Business Location Address –                          If you wish to change the information in Box B, please enter your
           correct location address in Field 5. Otherwise, leave Field 5 blank.
Field 6. New Mailing Address – Please enter your correct business mailing address.
Field 7. Out of Business checkbox (include Date Closed) –                         Please check this box if your location has currently
           gone out of business. Please enter the date your location stopped operations in the Date space provided.

Step 3: Sign and date the form. Mail to the address listed on the form or fax to 302-577-8203.