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DELAWARE DIVISION OF REVENUE REQUEST FOR CHANGE New Booklets Will Be Issued
04 PO BOX 830 for Business FEIN 04
05 WILMINGTON, DE 19899-0830 *DF62215019999* or SSN Changes Only 05
06 DF62215019999 06
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09 CHANGE: TAX YEAR ENDING DATE BUSINESS FEIN OR SSN CHANGE: BUSINESS FEIN OR SSN EFFECTIVE DATE REASON FOR CHANGE 09
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11 ACCOUNT NUMBER CORRECT BUSINESS LOCATION ADDRESS 11
12 NAME 12
13 OUT OF BUSINESS ADDRESS 13
14 EFFECTIVE DATE CITY STATE ZIP CODE 14
BUSINESS MAILINGADDRESS
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16 CORRECT MAILING ADDRESS IF DIFFERENT FROM ABOVE 16
17 NAME 17
18 ADDRESS 18
19 CITY STATE ZIP CODE 19
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21 TELEPHONE NUMBER 21
22 AUTHORIZED SIGNATURE EMAIL ADDRESS DATE 22
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