R-6450 (4/11)

                               Business Taxes Address Change Form

Check all the boxes that this change affects:       Effective Date of Change:

Do not complete a separate address change form if the new address applies to all taxes.
                                                                   Account Number
  Sales
                                                                   Account Number
  Withholding
                                                                   Account Number
  Corporate Income/Franchise
                                                                   Account Number
  Other (List appropriate tax)

Legal Name

Trade Name

                                              Location Address
Old Address                                   Suite           City                     State ZIP

New Address                                   Suite           City                     State ZIP

Contact Person                                                Daytime Telephone Number
                                                                         
                                              Mailing Address
Old Address                                   Suite           City                     State ZIP

New Address                                   Suite           City                     State ZIP

Contact Person                                                Daytime Telephone Number
                                                                         
               Request must be mailed or faxed to:   Louisiana Department of Revenue 
                                                    P.O. Box 201 
                                                    Baton Rouge, LA 70821 
                                                    Fax Number: 225-219-0806

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