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       Missouri Department Of Revenue                              Please complete only those lines that require changing.
       Change Of Name or Address
                                                                   New Name
  Please use this form to report any changes of mailing address or 
  name.
Social Security Number            Spouse’s Social Security Number  Spouse’s New Name

  __ __ __ ‑ __ __ ‑ __ __ __ __  __ __ __ ‑ __ __ ‑ __ __ __ __
Previous Name And Mailing Address                                  New Mailing Address

                                                                   City

                                                                   State              Zip Code
Mail To: Missouri Department of Revenue
         P.O. Box 555
         Jefferson City, MO 65105‑0555
                                                                                               (Revised 12‑2013)