State of Rhode Island Division of Taxation 
Form RI-2625 
                                                                                      14202399990101
Account Cancellation Form
Account name                                                                 Federal employer identification/social security number

Address                                                                      Sales tax permit number, if applicable

Address 2                                                                    Employer tax number, if applicable

City, town or post office        State       ZIP code                        E-mail address

Record to be canceled (check all that apply):

Effective Date of Cancellation:

Cigarettes/Tobacco/Other Tobacco                                       Meals and Beverage

Employee Leasing Organization                                          Prepaid Wireless Telecommunications

Hard-to-Dispose                                                        Sales and Use Tax

Hotel                                                                  Withholding Tax

Litter Tax                                                             Other ________________________

If business was sold, provide the purchaser's name and address, and the date the business was sold:

Purchaser name:

Purchaser address:

Date business sold:
Please note that the filing of this form is subject to review by the Division of Taxation and does not eliminate the 
requirement of filing all tax returns up to the effective date of this cancellation notice and paying all liabilities  in-
        cluding interest and penalty.  Additional requirements may apply in order to cancel some account types.
           Mail completed form to: RI Division of Taxation, One Capitol Hill, Providence, RI 02908 
                               or fax to the Registration Section at (401) 574-8913
Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, it is true, accurate and complete.   
             Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
 Authorized officer signature                Print name                               Date                Telephone number

 Paid preparer signature                     Print name                               Date                Telephone number

 Paid preparer address           City, town or post office             State ZIP Code                              PTIN

             May the Division of Taxation contact your preparer?   YES                     New 04/2021