Enlarge image | Arizona Form EFFECTIVE DATE Change of Address 822 M M D D 2 0 Y Y Use this form to notify the Arizona Department of Revenue of a change in your mailing address. Submit separate forms for home and business addresses. Please type or print. Check each box for the forms affected by this change: 1 Individual income tax returns (Arizona Forms 140, 140A, 140EZ, 140PY, 140NR, 140PTC, 141AZ) Check this box if your last return was a joint return and you are now establishing a residence separate from the spouse with whom you filed that return. 2 Business returns (Arizona Forms 99, 99T, 120, 120A, 120S, 141AZ, 165) 3a Name (Individuals: first name, middle initial, last name) 3b Your Social Security Number 3c Employer Identification Number 4a Spouse’s Name (first name, middle initial, last name) 4b Spouse’s Social Security Number 5 Prior Name (Complete this line if the name(s) has/have changed since last filing.) 6a Old Address (number and street or PO Box) Apt./Suite 6b Spouse’s Old Address (number and street or PO Box) Apt. No. (Complete line 6b only if different from address on line 6a.) City, Town or Post Office City, Town or Post Office State or Province ZIP or Postal Code State or Province ZIP or Postal Code Country (if foreign address) Country (if foreign address) 7 New Address (number and street or PO Box) Apt./Suite City, Town or Post Office State or Province ZIP or Postal Code Country (if foreign address) Print Your Signature Spouse’s Signature PLEASE SIGN HERE Date Date Mail to: Arizona Department of Revenue PO Box 29086 Phoenix, AZ 85038-9086 ADOR 10173 (16) |