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FORM MARYLAND CHANGE 2023
109-B OF ADDRESS
FOR BUSINESSES
Business Name Federal Identification number
Trade Name Central Registration Number
OLD ADDRESS
Mailing Address - Line 1
Mailing Address - Line 2 (PO Box, Apt No., Suite No.)
City or Town State ZIP Code
Telephone number Fax number Email address
NEW ADDRESS
Current Mailing Address - Line 1
Current Mailing Address - Line 2 (PO Box, Apt No., Suite No.)
City or Town State ZIP Code
Telephone number Fax number Email address
Check here to:
Request updated Sales and Use Tax License Request updated Sales and Use Tax forms
Please update my address information per the information above. I certify that the foregoing information is true, correct and
accurate to the best of my knowledge.
Print name Title (Owner, Partner or Officer)
Signature Date
COM/RAD 109-B 0 /5 23
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