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8822 Form (Rev. December 2004)

Department of the Treasury Internal Revenue Service

Change of Address

See instructions on back.

Please type or print.

  • Do not attach this form to your return.

OMB No. 1545-1163

Part I

Complete This Part To Change Your Home Mailing Address

Check all boxes this change affects:

1

Individual income tax returns (Forms 1040, 1040A, 1040EZ, TeleFile, 1040NR, etc.)

If your last return was a joint return and you are now establishing a residence separate from the spouse with whom you filed that return, check here

2

Gift, estate, or generation-skipping transfer tax returns (Forms 706, 709, etc.)

  • For Forms 706 and 706-NA, enter the decedent’s name and social security number below.

  • Decedent’s name

3a Your name (first name, initial, and last name)

  • Social security number

3b Your social security number

4a Spouse’s name (first name, initial, and last name)

4b Spouse’s social security number

5

Prior name(s). See instructions.

6a Old address (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

Apt. no.

6b Spouse’s old address, if different from line 6a (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

Apt. no.

7

New address (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

Apt. no.

Part II

Complete This Part To Change Your Business Mailing Address or Business Location

Check all boxes this change affects:

8 9 10

Employment, excise, income, and other business returns (Forms 720, 940, 940-EZ, 941, 990, 1041, 1065, 1120, etc.) Employee plan returns (Forms 5500, 5500-EZ, etc.) Business location

11a Business name

11b Employer identification number

12

Old mailing address (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

13

New mailing address (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

Room or suite no.

Room or suite no.

14

New business location (no., street, city or town, state, and ZIP code). If a foreign address, see instructions.

Room or suite no.

Part III

Signature

Daytime telephone number of person to contact (optional)

(

)

Sign Here

  • Your signature

  • If joint return, spouse’s signature

Date

Date

  • If Part II completed, signature of owner, officer, or representative Date

  • Title

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Cat. No. 12081V

Form 8822 (Rev. 12-2004)

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