Rev. 2/96

        M
  DEPARTMAETENPETESISPLSNACAIDA MCTHSVOUBLSIBEATEFRTEETIOVMTERTSEVENEUMASSACHUSETTS DEPARTMENT OF REVENUE
                                                                            Taxpayer Change of Address

Name ________________________________ SS. No. _____________________________
Name of Spouse________________________ SS. No. _____________________________
Old Address ________________________________________________________________
__________________________________________________________________________
New Address _______________________________________________________________
__________________________________________________________________________
Type of Return Filed:
                                                                      Form 1      TelefileForm 3
                                                                      Form 1-NR/PYForm 2  Other _________________________

Signature: ____________________________________ Date: ________________________

Send to: Massachusetts Department of Revenue, P.O. Box 7011, Boston, MA 02204.