Change of Address / Name, 150-800-735
Change of Address / Name
Clear Form
For office use only Date received
? You may fill this form out on your computer, print it, and send it to us; or you may print it, fill it out by hand, and send it to us. ? We can not accept e-mailed forms because of disclosure laws (which protect your confidentiality). You must send your form to us. ? Do not attach this form to your return. ? Send your signed and completed form to the address or fax number listed below.
Check all the boxes that apply: You are establishing a residence separate from the spouse included on the last individual income tax return filed. Address change. Name change. I am signing as the taxpayer's representative and have attached a completed Authorization to Represent form.
Effective date of change(s): _____________________________________
Your name
Last
First
M.I.
Your Social Security number
Spouse's name Last
First
M.I.
Spouse's Social Security number
Former name Last
First
M.I.
Other former name(s)
New mailing address
City
State
ZIP / Postal code
Country
Old mailing address
City
State
ZIP / Postal code
Country
Spouse's old mailing address
(if different than above)
City
State
ZIP / Postal code
Country
Under penalties for false swearing, I declare that I have examined this document and to the best of my knowledge and belief, it is true, correct, and complete.
( Daytime telephone number of person to contact:
)
Your signature
Date
SIGN X
HERE Spouse's signature (if joint)
Date
X
INSTRUCTIONS
Purpose of Form
This form may be used to notify the Oregon Department of Revenue of changes to your home mailing address or name. One form may be used if the change applies to both you and your spouse. Separate forms should be used if the change applies only to you. If the change also affects the mailing address for your children who filed income tax returns, complete and send us a separate form for each child. Attach an Authorization to Represent form if you are a representative signing for the taxpayer.
Spouse's Name and Social Security Number
Complete this section if an address change affects both you and your spouse. Do not complete this section if the change affects only you.
Former Name(s) Complete this section if you changed your name because of marriage, divorce, etc. Also list any other former name(s).
Mailing Addresses Be sure to include any apartment, room, or suite number.
Where to Send Fax your signed, completed form to: 503-945-8073
Mail your signed, completed form to: TPID Unit Oregon Department of Revenue 955 Center Street NE Salem OR 97301-2555
150-800-735 (03-08)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- mailing addresses for d c tax returns form mailing
- rt 6n employer s quarterly report instructions
- d0 5 name or address change form rev 12 18
- i tax change of address form alabama department of revenue
- tennessee department of revenue change of address
- 10a104 06 17 update or cancellation of kentucky tax
- pennsylvania department of revenue mailing addresses
- 2019 st 1 sales and use tax and e911 surcharge return
- business taxes address change form louisiana revenue
- change of address name 150 800 735
Related searches
- usps change of address update
- usps change of address request
- usps change of address form free
- usps change of address online for free
- change of address form for usps
- change of address on license
- new york life change of address form
- change of address magazine subscriptions
- change of address irs 8822
- wells fargo change of address online
- 941 change of address form
- change of address post office