City of Golden
                                                    Sales Tax Division
                                                    911 10th Street
                                                    Golden, CO  80401
                          (303) 384-8023,   Fax (303) 384-8001

                          ACCOUNT CHANGE OR CLOSURE FORM

Use this form to notify the City of Golden of any change in the trade name (or d/b/a), change of business
or mailing address, or to notify the city that you want to close your tax account.  If you are closing your 
account please indicate the appropriate reason.

Account Number

                          TRADE NAME OR ADDRESS CHANGE

Current Name and Address:                           New Business Name And/Or Address

                                                    Business Address_____  Mailing Address_____   Both_____

                     CHANGE OF OWNERSHIP/BUSINESS CLOSURE

Last Day of Business            /          /        New Ownership Information/Name/Address
Reason:
Ownership has changed
Business has been permanently closed
Business has been sold

By my signature below, I declare, under the penalty of perjury, that the statements made 
herein are to the best of my knowledge true and correct.
Authorized Signature

Printed Name

Title: Date: