Government of the 
      District of Columbia FR-COA    Change of Name, Address or Identification Number
                                                                                                 OFFICIAL USE
Important: Print in CAPITAL letters using black ink. 
 
Taxpayer Identification Number (TIN)                             DC assigned account ID
                                         Fill in if         FEIN 
                                         Fill in if         SSN
Legal name of entity (or individual) for the TIN listed      

Trade name of business (if different from Legal name)      

Business address

City                                                                                       State Zip Code + 4

Mailing address

City                                                                                       State Zip Code + 4

Name of responsible party     

New Taxpayer Identification Number (TIN)                         DC assigned account ID
                                         Fill in if         FEIN 
                                         Fill in if         SSN
New Legal name of entity      

New Business address

City                                                                                       State Zip Code + 4

New Mailing address

City                                                                                       State Zip Code + 4

New Name of responsible party     

Name of person completing form if not responsible party     

Contact telephone number     

Contact email address

Signature                                                                              Date

INSTRUCTIONS

This form may be used to make a name, address or identification number change.

Note: “Articles of Amendment” must be submitted with this form if requesting a name change.  If requesting a FEIN change, attach
a copy of the IRS notification and refer to the rules for the new FEIN in IRS Publication 1635.

Identity of Responsible Party is the true principal officer, general partner, grantor, owner or trustor.  This individual or entity, which 
the IRS will call the “responsible party,” controls, manages, or directs the applicant entity and the disposition of its funds and assets.

Mail the completed form along with any attachment to the Office of Tax and Revenue, PO Box 470, Washington, DC 20044-0470

If you are completing this form online, please upload any attachments or your request will be unable to be processed.
                                                                 FR-COA 
                                         Change of Name, Address or Identification Number
Rev. 07/16