Change of Address Form 8822 OMB No. 1545-1163

Expires 5-31-95 (Rev. May 1994) © 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, 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 Employment tax returns for household employers (Forms 942, 940, and 940-EZ)

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

4a Your name (first name, initial, and last name) 4b Your social security number

5a Spouse’s name (first name, initial, and last name) 5b Spouse’s social security number

6 Prior name(s). See instructions.

7b Spouse’s old address, if different from line 7a (no., street, city or town, state, and ZIP code). If a P.O. box or foreign address, see instructions.

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

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

Please

Sign

Here

If joint return, spouse’s signature Date Title

Cat. No. 12081V Form 8822 (Rev. 5-94)

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

Complete This Part To Change Your Home Mailing Address

© Enter your employer identification number here ©

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

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

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

12a Business name 12b Employer identification number

Check ALL boxes this change affects:

9

10

11

Employment, excise, and other business returns (Forms 720, 941, 990, 1041, 1065, 1120, etc.)

Employee plan returns (Forms 5500, 5500-C/R, and 5500-EZ). See instructions.

©

©

©

©

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

15 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.

© Name © Social security number
Form 8822 (Rev. 5-94) Page 2

California (all other

counties), Hawaii

Employee Plan Returns ONLY

Send this form to the Internal Revenue (Form 5500 series)

Service Center shown below for your

old address. But if you checked the box

on line 10 (employee plan returns), send

it to the address shown in the far right

column.

Fresno, CA 93888

Indiana, Kentucky, Michigan,

Ohio, West Virginia Cincinnati, OH 45999

Use this address:

If the principal office of

the plan sponsor or the

plan administrator

was in:

Kansas, New Mexico,

Oklahoma, Texas Austin, TX 73301

Delaware, District of

Columbia, Maryland,

Pennsylvania, Virginia

If your old

address was in:

Philadelphia, PA 19255

Connecticut, Delaware,

District of Columbia,

Maine, Maryland,

Massachusetts, New

Hampshire, New Jersey,

New York, Pennsylvania,

Puerto Rico, Rhode Island,

Vermont, Virginia

Alabama, Arkansas, Louisiana,

Mississippi, North Carolina,

Tennessee

Florida, Georgia,

South Carolina

Holtsville, NY 00501

Atlanta, GA 39901

Memphis, TN 37501

New Jersey, New York (New

York City and counties of

Nassau, Rockland, Suffolk,

and Westchester)

Illinois, Iowa, Minnesota,

Missouri, Wisconsin Kansas City, MO 64999

Holtsville, NY 00501

American Samoa Philadelphia, PA 19255

Alabama, Alaska, Arkansas,

California, Florida, Georgia,

Hawaii, Idaho, Louisiana,

Mississippi, Nevada, North

Carolina, Oregon, South

Carolina, Tennessee,

Washington

New York (all other

counties), Connecticut,

Maine, Massachusetts,

New Hampshire, Rhode

Island, Vermont

Department of Revenue

and Taxation

Government of Guam

378 Chalan San Antonio

Tamuning, GU 96911

Andover, MA 05501

Guam:

Permanent residents

Atlanta, GA 39901

Guam:

Nonpermanent residents

Puerto Rico (or if excluding

income under section 933)

Virgin Islands:

Nonpermanent residents

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

Philadelphia, PA 19255

Arizona, Colorado, Illinois,

Indiana, Iowa, Kansas,

Kentucky, Michigan,

Minnesota, Missouri,

Montana, Nebraska, New

Mexico, North Dakota, Ohio,

Oklahoma, South Dakota,

Texas, Utah, West Virginia,

Wisconsin, Wyoming

V. I. Bureau of

Internal Revenue

Lockhart Gardens No. 1-A

Charlotte Amalie,

St. Thomas, VI 00802

Virgin Islands:

Permanent residents

Memphis, TN 37501

Ogden, UT 84201

Foreign country:

U.S. citizens and those

filing Form 2555,

Form 2555-EZ, or

Form 4563

Philadelphia, PA 19255

All Form 5500-EZ filers Andover, MA 05501

Philadelphia, PA 19255 All A.P.O. and F.P.O.

addresses

Privacy Act and Paperwork

Reduction Act Notice

We ask for this information 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 also give it to cities, states, the

District of Columbia, and U.S.

commonwealths or possessions to carry

out their tax laws. And we may give it to

foreign governments because of tax

treaties they have with the United

States.

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 more

simple, we would be happy to hear from

you. You can write to both the Internal

Revenue Service, Attention: Reports

Clearance Officer, PC:FP, Washington,

DC 20224; and the Office of

Management and Budget, Paperwork

Reduction Project (1545-1163),

Washington, DC 20503. DO NOT send

this form to either of these offices.

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. Generally,

complete only one Form 8822 to change

your home and business addresses. 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 due to marriage, divorce, etc.,

complete line 6. 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

P.O. Box

If your post office does not deliver mail

to your street address and you have a

P.O. box, show the box number instead

of your street address.

Foreign Address

If your address is outside the United

States or its possessions or territories,

enter the information in the following

order: number, street, city, province or

state, postal code, and country. Do not

abbreviate the country name. Be sure to

include any apartment, room, or suite

number in the space provided.

Where To File

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.

Employee Plan Returns

A change in the mailing address for

employee plan returns must be shown

on a separate Form 8822 unless the

Exception below applies.

Exception. If the employee plan returns

were filed with the same service center

as your other returns (individual,

business, employment, gift, estate, etc.),

you do not have to use a separate Form

8822. See Where To File below.

Use this address:

Note: If you moved after you filed your

return and you are expecting a refund,

also notify the post office serving your

old address. This will help forward your

check to your new address. Foreign country Holtsville, NY 00501

processing your return and issuing

refunds. It also safeguards your future

social security benefits.

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