City of Walker
                                           Income Tax Department

                 NOTICE OF CHANGE OR DISCONTINUANCE
ACCOUNT NUMBER                                        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 Walker.
                 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 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
                                                                                                     (      )
       MAIL THIS NOTICE AND ANY CORRESPONDENCE TO:  WALKER CITY INCOME TAX, P.O. BOX 153, GRAND RAPIDS, MI  49501-0153