Change of Address Form 8822

OMB No. 1545-1163 (Rev. December 2003)  Please type or print.

Department of the Treasury

Internal Revenue Service

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.)

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

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.

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

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

Sign

Here

If joint return, spouse’s signature Date Title

Cat. No. 12081V Form 8822 (Rev. 12-2003)

 See instructions on back.  Do not attach this form to your return.

Complete This Part To Change Your Home Mailing Address

Apt. no.

Apt. no.

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

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

Daytime telephone number of person to contact (optional)  ( )

Signature

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

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

11a Business name 11b Employer identification number

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.).









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

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

Business location

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

Room or suite no.

Room or suite no.

Part III

Part I

Part II

Apt. no.

 Decedent’s name  Social security number
Form 8822 (Rev. 12-2003) Page 2

Send this form to the Internal Revenue

Service Center shown next that applies to

you.

Fresno, CA 93888

Connecticut,

District of Columbia,

Maryland, New Jersey,

Pennsylvania

IF your old home mailing

address was

in . . .

Philadelphia, PA 19255

Ohio, Virginia

Alabama, Florida, Georgia,

Mississippi, North Carolina,

Rhode Island, South Carolina,

West Virginia

Atlanta, GA 39901

Memphis, TN 37501

Delaware, Illinois, Indiana,

Iowa, Kansas, Michigan,

Minnesota, Missouri,

Nebraska, North Dakota,

South Dakota, Wisconsin

Kansas City, MO 64999

American Samoa Philadelphia, PA 19255

Maine, Massachusetts,

New Hampshire, New York,

Vermont

Department of Revenue

and Taxation

Government of Guam

P.O. Box 23607

GMF, GU 96921

Andover, MA 05501

Guam:

Permanent residents

Guam:

Nonpermanent residents

Puerto Rico (or if excluding

income under Internal

Revenue Code section

933)

Virgin Islands:

Nonpermanent residents

Philadelphia, PA 19255

V. I. Bureau of

Internal Revenue

9601 Estate Thomas

Charlotte Amalie

St. Thomas, VI 00802

Virgin Islands:

Permanent residents

Foreign country:

U.S. citizens and those

filing Form 2555,

Form 2555-EZ, or

Form 4563

Philadelphia, PA 19255

All APO and FPO addresses

Privacy Act and Paperwork Reduction

Act Notice. We ask for the information on

this form to carry out the Internal Revenue

laws of the United States. We may give the

information to the Department of Justice

and to other Federal agencies, as provided

by law. We may give it to cities, states, the

District of Columbia, and U.S.

commonwealths or possessions to carry

out their tax laws. We may give it to

foreign governments because of tax

treaties they have with the United States.

We may also give this information to

Federal and state agencies to enforce

Federal nontax criminal laws and to

combat terrorism.

The time needed to complete and file

this form will vary depending on individual

circumstances. The estimated average time

is 16 minutes.

If you have comments concerning the

accuracy of this time estimate or

suggestions for making this form simpler,

we would be happy to hear from you. You

can write to the Tax Products Coordinating

Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001.

Do not send the form to this address.

Instead, see Where To File on this page.

Purpose of Form

You may use Form 8822 to notify the

Internal Revenue Service if you changed

your home or business mailing address or

your business location. If this change also

affects the mailing address for your

children who filed income tax returns,

complete and file a separate Form 8822 for

each child. If you are a representative

signing for the taxpayer, attach to Form

8822 a copy of your power of attorney.

Prior Name(s)

If you or your spouse changed your name

because of marriage, divorce, etc.,

complete line 5. Also, be sure to notify the

Social Security Administration of your

new name so that it has the same name in

its records that you have on your tax

return. This prevents delays in processing

your return and issuing refunds. It also

safeguards your future social security

benefits.

P.O. Box

Enter your box number instead of your

street address only if your post office does

not deliver mail to your street address.

Foreign Address

Enter the information in the following order:

city, province or state, and country. Follow

the country’s practice for entering the

postal code. Please do not abbreviate the

country name.

Where To File

The use of this form is voluntary.

However, if you fail to provide the Internal

Revenue Service with your current mailing

address, you may not receive a notice of

deficiency or a notice and demand for tax.

Despite the failure to receive such notices,

penalties and interest will continue to

accrue on the tax deficiencies.

THEN use this

address . . .

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB

control number. Books or records relating

to a form or its instructions must be

retained as long as their contents may

become material in the administration of

any Internal Revenue law. Generally, tax

returns and return information are

confidential, as required by section 6103.

Alaska, Arizona, California,

Hawaii, Idaho, Montana,

Nevada, Oregon, Utah,

Washington, Wyoming

Addresses

Be sure to include any apartment, room, or

suite number in the space provided.

Signature

If you are completing Part II, the owner, an

officer, or a representative must sign. An

officer is the president, vice president,

treasurer, chief accounting officer, etc. A

representative is a person who has a valid

power of attorney to handle tax matters or

is otherwise authorized to sign tax returns

for the business.

Filers Who Checked the Box on

Line 1 and Completed Part I

Changing Both Home and Business

Addresses? If you are, use a separate

Form 8822 to show each change.

IF your old business address

was in . . .

Outside the United States Philadelphia, PA 19255

Connecticut, Delaware,

District of Columbia, Illinois,

Indiana, Kentucky, Maine,

Maryland, Massachusetts,

Michigan, New Hampshire,

New Jersey, New York, North

Carolina, Ohio, Pennsylvania,

Rhode Island, South Carolina,

Vermont, Virginia, West

Virginia, Wisconsin

Cincinnati, OH 45999

THEN use this

address . . .

Filers Who Checked the Box on

Line 2 or Completed Part II

Arkansas, Colorado, Kentucky,

Louisiana, New Mexico,

Oklahoma, Tennessee, Texas

Austin, TX 73301

Alabama, Alaska, Arizona,

Arkansas, California,

Colorado, Florida, Georgia,

Hawaii, Idaho, Iowa,

Kansas, Louisiana,

Minnesota, Mississippi,

Missouri, Montana,

Nebraska, Nevada, New

Mexico, North Dakota,

Oklahoma, Oregon, South

Dakota, Tennessee, Texas,

Utah, Washington,

Wyoming

Ogden, UT 84201

Our legal right to ask for information is

Internal Revenue Code sections 6001 and

6011, which require you to file a statement

with us for any tax for which you are liable.

Section 6109 requires that you provide

your social security number on what you

file. This is so we know who you are, and

can process your form and other papers.

If you checked the box on line

2, see Filers Who Checked

the Box on Line 2 or

Completed Part II for where to

file this form.

Dual-status aliens