GR-6-IT 
                                   City of Grand Rapids 
                                   Income Tax Department                                                                                                                                                                  Rev. 10/98 
                                                           
                      NOTICE OF CHANGE OR DISCONTINUANCE 
                                                           
ACCOUNT NUMBER (FEIN)                                   CHANGES EFFECTIVE ON (Date) 
                                                         
CURRENT LEGAL NAME                                      CHANGE LEGAL NAME TO: 
                                                         
DBA                                                     CHANGE DBA TO: 
                                                         
CURRENT LEGAL BUSINESS ADDRESS                          CHANGE LEGAL BUSINESS ADDRESS TO: 
                                                         
MAILING ADDRESS                                         CHANGE MAILING ADDRESS TO: 
                                                         
      Instructions:  Place an “X” in all boxes that apply.  Complete all information for that change.       
                               Write any comments or explanations on back of form.       
                                                           
‰ 1. The Internal Revenue Service assigned us Federal Employer Identification Number: ___________________    
 
‰ 2. Our Federal Employer Identification Number is wrong.  The correct number is:  _______________________   
 
‰ 3. We have incorporated.  Our corporate name is:   _______________________________________________                                                                                                                       
 
‰ 4. Our new corporate Federal Employer Identification Number is:   ___________________________________                                                                                                                    
 
‰ 5. Discontinue our withholding tax registration:   
 
     ‰ We no longer have any business activity in the City of Grand Rapids. 
      
     ‰ We closed our business on:               
       
     ‰ We sold our entire business on:                    We sold our business to: 
           
     ‰ We sold part of our business on:         
                                                           Their FEIN is:
 
‰ 6. Address and phone number where we may be reached following discontinuance of business: 
   ______________________  _____________________  _____________  ____  _________  _____________ 
                  CONTACT PERSON                                   STREET ADDRESS                                 CITY                    STATE       ZIP  CODE                    PHONE 
 
‰ 7. Change in ownership.  (Please explain on back) 
 
‰ 8. Effective _________________, we changed our fiscal year ending from __________ to __________ 
                                                  MONTH/YEAR                                                                                                                          MONTH                         MONTH 
                 
‰ 9. Other changes.  (Please explain on back) 
 
SIGNATURE OF PREPARER          PRINTED NAME OF PREPARER    DATE PREPARED            PREPARER’S PHONE 
                                                                                    NUMBER 
                                                                                    (      )         - 
MAIL THIS NOTICE AND ANY CORRESPONDENCE TO:  GRAND RAPIDS  INCOME TAX  DEPT., P.O. BOX 347, GRAND RAPIDS, MI  49501-0347