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DR 1102 (07/19/22)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
*221102==19999* Page 1 of 2
Address or Name Change Form
Use this form to notify the Department of Revenue by Note: A new Federal Employer Identification Number
selecting the appropriate accounts for the address change. (FEIN) assigned by the IRS or a change in ownership
(and you are the new owner) will require a new Colorado
To change the address for a specific physical location Account Number. Please fill out a Colorado Sales Tax and
you operate or sell into, refer to your sales tax license for Withholding Account Application (CR 0100) by visiting
the 8 digit Colorado Account number followed by a 4 digit Tax.Colorado.gov/forms-in-number-order.
location (site) number and indicate in the boxes below. Be
sure to include the effective date for the address change Revenue Online allows for convenient and secure access to
to avoid incorrect assessments of tax liability. If there conduct business with the Department of Revenue. If you
are multiple address changes for multiple account types, have a login, you can also change your mailing address for
please list the information on page 2. certain accounts online at Colorado.gov/RevenueOnline.
Colorado Account Number (8-Digit Number) FEIN or SSN/ITIN Business Name or Last Name, First Name
Apply address change to account(s)
Withholding Tax Gaming Withholding Excise Individual Corporate
1099 Withholding Oil & Gas Withholding IFTA Partnership Other (list account)
4 Digit Location (Site) Number to Change Effective Date of Change (MM/DD/YY)
Sales Tax Location (Site) Address Change Only
Note: If your retail business location changed Change Main Address
in the middle of a filing period, you must file a
separate sales tax return for the taxes collected Mailing Address Physical Address Both
at each location
Previous Address Current Address
Previous Address Current Address
City County City County
State ZIP Code Phone Number State ZIP Code Phone Number
For business name change, provide a copy of the IRS SS-4 and/or Amended Articles of Incorporation from the
Secretary of State.
For individual name change, provide either a copy of your state ID or driver’s license, social security card,
marriage certificate, divorce decree, or court document
Name Change Current or Previous Name New Name
Legal DBA
Authorized Signature Date
Email to: DOR_taxapplications@state.co.us, or
Mail to: Colorado Department of Revenue, Taxpayer Service Center,
PO Box 17087, Denver, CO 80217-0087
