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           Illinois Department of Revenue

           REG-3-C   Business Information Update

Step 1:  Read this information first
Complete the following information to update your registration information. To change or update your responsible party, complete 
Schedule REG-1-R, Responsible Party Information. Mail your completed information to Illinois Department of Revenue, P.O. Box 19030,  
Springfield, Illinois, 62794-9030. You can fax your information to217 785-6013  or217 557-4398                                                               .

Step 2:  Identify your current business 
 1  __________________________________________________________                                                                                         4      FEIN or SSN:  _____________________
         Business name                                                                                                                                                             

 2  __________________________________________________________                                                                                        5      (_____)_____ - __________
         Number and street                                                              City                                      State         ZIP           Telephone
                                         
 3  _________________________________________________________
         Email address
                            
Step 3:  Discontinuation or sale of entire business - If you sold your business, Form CBS-1, Notice of Sale, Purchase, or    
                 Transfer of Business Assets, may be required. Visit our website at tax.illinois.gov for more information. 
 6       Date this became effective:  ____/____/________

Step 4:  Change business name - If your FEIN has changed due to a name change, you must complete a new Form REG-1, Illinois  
                 Business Registration Application.  For a copy or to register on-line, visit our website attax.illinois.gov. 
  
 7       Previous legal business name: _________________________   New legal business name: ___________________________  
 8       Previous DBA name: _______________________________  New DBA name: ___________________________________ 
           
Step 5:  Change current address
a        Legal address - Date this became effective: ____/____/________
 9  __________________________________________________________                                                                                        12      (_____)_____ - __________
        Number and street                                                                      City State                          ZIP                        Telephone 
          
10   __________________________________________________________                                                                                       13     _________________________________
         County                                                                                                                                              Township
11       Identify the taxes affected by this change  (e.g., sales, hotel, etc.). ____________________________
 
b        Mailing address - Date this became effective: ____/____/________ 
14  __________________________________________________________                                                                                        17  (_____)_____ - __________
        Number and street                                                                      City State                          ZIP                        Telephone
 
15  __________________________________________________________ 
         In care of name                                                                                                                                     
 
16       Identify the taxes affected by this change  (e.g., sales, hotel, etc.). ____________________________

Step 6:  Add a location - Date this became effective: ____/____/________   Complete Schedule REG-1-L, Illinois Business Site  
                   Location Information, to add more than one location. For a copy or to add a location on-line, visit our website at tax.illinois.gov.  
18  __________________________________________________________                                                                                        21      (_____)_____ - __________
         Number and street                                                                     City State                          ZIP                        Telephone
19       Check the best physical description of this location:                                                                        permanent          one that will change (e.g., fairs, flea market)
20       Is the address outside the city limits?                                                                                      yes                no 

Step 7:  Close a location - Date this location closed: ____/____/________
                 If closing more than one location, attach a separate sheet following the same format as below including the date closed.
 
22  __________________________________________________________  
          Number and street                                                              City                                      State        ZIP            
          
23   __________________________________________________________                                                                                       24     _________________________________
         County                                                                                                                                              Township

REG-3-C front (R-05/16)

Step 8:  Change your owner or officer information  
25     Individuals - Social Security Numbers (SSN) required:
    a         ___________________________________                                 _________________                                                      c   ___________________________________                                  _________________
              Name                                                                 Title                                                                     Name                                                                  Title 
             ______________________________________________________                                                                                               ______________________________________________________           
              Home   address - No PO Box number             City                                State                     ZIP                                Home   address - No PO Box number             City                                State                     ZIP
              ____ / ____ / ________                                 (______) ______ - ________                                                              ____ / ____ / ________                                  (______) ______ - ________    
              Date of birth                                          Telephone                                                                               Date of birth                                           Telephone   
              _______ - _____ - _________  Ownership percentage: ______                                                                                      _______ - _____ - _________  Ownership percentage: ______ 
              Social Security number                                                                                                                         Social Security number
    b         ___________________________________                                 _________________                                                      d   ___________________________________                                  _________________
              Name                                                                 Title                                                                     Name                                                                  Title 
             ______________________________________________________                                                                                               ______________________________________________________           
              Home   address - No PO Box number             City                                State                     ZIP                                Home   address - No PO Box number             City                                State                     ZIP
              ____ / ____ / ________                                 (______) ______ - ________                                                              ____ / ____ / ________                                  (______) ______ - ________    
              Date of birth                                          Telephone                                                                               Date of birth                                           Telephone    
              _______ - _____ - _________  Ownership percentage: ______                                                                                      _______ - _____ - _________  Ownership percentage: ______ 
              Social Security number                                                                                                                         Social Security number

26     Businesses  - Federal Employers Identification Numbers (FEIN) required
   a         ___________________________________                                  ____-_____________                                                    b    ___________________________________                                  ____-_____________
             Name                                                                 FEIN                                                                       Name                                                                 FEIN
                                                                                                                                                      
             ______________________________________________________                                                                                          ______________________________________________________           
             Legal  address                                                                                                                                  Legal  address                                          
                                                                                                                                                       
             ______________________________________________________                                                                                          ______________________________________________________           
             City                                                                                                State                           ZIP         City                                                                                                State                           ZIP 
             (______) ______ - ________                               Ownership percentage: ______                                                           (______) ______ - ________   Ownership percentage: ______
             Telephone                                                                                                                                       Telephone    

Step 9:  Remove owners and officers
27  Complete the following information (including the Social Security number) if you need to remove an owner or officer from our registration records.

    a        ___________________________________                                  _________________                                                      b   ___________________________________                                  _________________
             Name                                                                  Title                                                                     Name                                                                  Title 
              ____ / ____ / ________                                 (______) ______ - ________                                                              ____ / ____ / ________                                  (______) ______ - ________    
             Date of birth                                           Telephone                                                                               Date of birth                                           Telephone   
             _______ - _____ - _________         ____ / ____ / ________                                                                                      _______ - _____ - _________         ____ / ____ / ________ 
             Social Security number                                               Date ceased as owner/officer                                               Social Security number                                               Date ceased as owner/officer

Step 10:  Identify a contact person regarding your business
28  Name: __________________________________________   Title: _____________________________________________
29  (______) ______ - _______________                                                      (______) ______ - ________                                                                         _________________________
       Telephone                                                                            Fax                                                                                               Email address 

Step 11: Comments
       ____________________________________________________________________________________________________
       ____________________________________________________________________________________________________
       ____________________________________________________________________________________________________
       ____________________________________________________________________________________________________

Step 12:  Sign below
       Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete. 

       Signature: _________________________________________     Title: ______________________                                                                                                       Date:___/___/______
        
       ____________________________________________      (_____)_____ - __________
       Printed name                                                                                                               Telephone
                                                                                         Reset                                                              Print
                                 This form is authorized by 20 ILCS 687/6-1 et seq.; 35 ILCS 5/1et seq.,105/1et seq., 110/1et seq., 115/1et seq., 120/1et seq., 130/1et seq., 135/1 et seq., 143/10-1et seq., 155/1 et seq., 505/1et seq., 510/1et seq., 
                                 615/1et seq., 620/1 et seq., 625/1et seq., 630/1et seq., 635/1et seq.; 636/5-1 et seq.; 640/2-1 et seq.; 230 ILCS 20/1 et seq.; 25/1et seq., 30/1et seq.; 235 ILCS 5/1-1 et seq.; 305 ILCS 20/5 et seq., 415 ILCS 5/55.8; 415 
REG-3-C back (R-05/16)           ILCS 125/301et seq.; Disclosure of this information may be REQUIRED. Failure to provide information could result in this form not being processed and possible penalties.