Form 8 8 2 2 Change of Address ome no. 15851163

(March 1990) | Expires 3-31-93
Department of the Treasury > Please type or print.

Internal Revenue Service

You may use this form to notify the Internal Revenue Service if you change your mailing address. Mail it to the Internal
Revenue Service Center for your old address. You can find the addresses of the Service Centers on the back of this form. If
you are changing both your home and business addresses, please complete two separate forms. However, individuals who
are also household employers and file Form 942 can use one form. They should be sure to check boxes 1 and 2 and complete
lines 5b and 5c in addition to any other lines that apply

Check ALL boxes that this change affects:

1 (1 Individual income tax returns (Forms 1040, 1040A, 1040EZ, 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 >O

20 Employment, excise, and other business returns (Forms 720, 941, 942, 1041, 1065, 1120, etc.)
30 Gift, estate, or generation-skipping transfer tax returns (Forms 706, 709, etc.)
40 Employee plan returns (Forms 5500, 5500 C/R, and 5500EZ)

5a Name (first name, initial, and last name for individuals) 5b Your Social Security Number

5c Employer Identification Number

6a Spouse’s Name (first name, initial, and last name) 6b Spouse's Social Security Number

7 Prior Name. (Complete this item if you or your spouse changed last name due to marriage, divorce, etc )

8a Old Address: Number street, and apt. or suite no. 8b Spouse’s Old Address: Number street, and apt. or suite no.
(Complete only if different from address on line 8a.)

City, town or post office, state and ZIP code. (If a foreign address, enter City, town or post office, state and ZIP code. (If a foreign address, enter
city, province or state, postal code, and country.) city, province or state, postal code, and country.)

9 New Address: Number street, and apt. or suite no. (or P.O. box number if mail is not delivered to street address)

City, town or post office, state and ZIP code. (If a foreign address, enter city, province or state, postal code, and country.)

Please
Sign >
Here Your signature Date Spouse's signature Date
Paperwork Reduction Act Notice. — Use of this Ifyou have comments concerning the accuracy of Management and Budget, Paperwork Reduction
form's optional It is provided for your convenience _this time estimate or suggestions for making this Project (1545-1163), Washington, DC 20503.
to notify IRS of a change of address. form more simple, we would be happy to hear from Please do not send this form to either of the

The time needed to complete and file this form you. You can write to the Internal Revenue Service, above addresses. Instead, mail it to the Internal
will vary depending on individual circumstances. The Washington, DC 20224, Attention: IRS Reports Revenue Service Center address on the back of this,

Clearance Officer. T:FP: and the Office of

estimated average time 1s 10 minutes. form.

Form 8822 (3-90)


Form 8822 (3-90)

Page 2

Send this form to the Internal Revenue
Service Center address that applies to you
If this form is for an Employee plan return
(Form 5500 series), send it to the address
in the far right column.
Send this form to the
Internal Revenue
ityour old Service Center at the
address was in: following address:

Vv a4

South Garonne Atlanta, GA 39901

New Jersey, New York (New
York City and counties of
Nassau, Rockland, Suffolk,
and Westchester)

New York (all other
counties), Connecticut,
Maine, Massachusetts,
New Hampshire, Rhode
Island, Vermont

Holtsville, NY 00501

Andover, MA 05501

‘Alaska, Arizona, California
(counties of Alpine, Amador,
Butte, Calaveras, Colusa,
Contra Costa, Del Norte, El
Dorado, Glenn, Humboldt,
Lake, Lassen, Marin,
Mendocino, Modoc, Napa,
Nevada, Placer. Plumas,
Sacramento, San Joaquin,
Shasta, Sierra, Siskiyou,
Solano, Sonoma, Sutter,
Tehama, Trinity, Yolo, and
Yuba), Colorado, Idaho,
Montana, Nebraska, Nevada,
North Dakota, Oregon, South
Dakota, Utah, Washington,
Wyoming

Ogden, UT 84201

California (all other

counties), Hawatt Fresno, CA 93888

Indiana, Kentucky, Michigan,

Gm Wiest Virgins Cincinnats, OH 45999

Kansas, New Mexico,

Oklahoma, Texas Austin, TX 73301

Delaware, District of
Columbia, Maryland,
Pennsylvania, Virginia

Pinladelphia, PA 19255

Alabama, Arkansas, Louisiana,
Mississipp1, North Carolina,
Tennessee

Memphis, TN 37501

Uihnors, lowa, Minnesota,

Missoun, Wisconsin Kansas City, MO 64999

Employee Plan Returns ONLY
(FORM 5500 SERIES)

Send this form to the
Internal Revenue

If the principal office of

the plan sponsor or the

plan administrator was Service Center at the
located in: following address:

Vv Vv

Connecticut, Delaware, District
of Columbia, Foreign Address,
Maine, Maryland,
Massachusetts, New
Hampshire, New Jersey, New
York, Pennsylvania, Puerto
Rico, Rhode Island, Vermont,
Virginia

Holtsville, NY 00501

American Samoa Philadelphia, PA 19255

Commissioner of Revenue and Taxation
855 West Marine Dr
Agana, GU 96910

Guam

Puerto Rico (or if excluding
income under section 933)
Virgin Islands
Nonpermanent residents

Philadelphia, PA 19255

V.1 Bureau of Internal Revenue
Lockharts Garden No 1A
Charlotte Amalie,

St Thomas, VI 00802

Virgin Islands
Permanent residents

Foreign country
US. citizens and those filing Philadelphia, PA 19255
Form 2555 or Form 4563

AIA PO. or F P O addresses Philadelphia, PA 19255

Alabama, Alaska, Arkansas,
California, Fonda, Georgia,
Hawaii, Idaho, Louisiana,
Mississippi, Nevada, North
Carolina, Oregon, South
Carolina, Tennessee,
Washington

Atlanta, GA 39901

Anzona, Colorado, Hlinors,
Indiana, lowa, Kansas,
Kentucky, Michigan,
Minnesota, Missouri,
Montana, Nebraska, New
Mexico, North Dakota, Ohio,
Oklahoma, South Dakota,
Texas, Utah, West Virginia,
Wisconsin, Wyoming

Memphis, TN 37501

All Form 5500EZ filers Andover. MA 05501