DOR: Change of Address Form for Individuals

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DOR > Individual Taxpayers > Change of Address Form for Individuals Change of Address Form for Individuals

Who is preparing this form?
Please enter the following information of the person preparing this form so that we can contact you if necessary.

:: These are required fields.

:: First Name:
:: Last Name:
Daytime Phone Number (xxxxxxxxxx no dashes):
Evening Phone Number (xxxxxxxxxx no dashes):
Email Address:

Name of Individual:
:: First Name:
Middle Initial:
:: Last Name:
:: Last four digits of SSN: XXX-XX-

Enter your entire Old Mailing Address:
:: Address:
:: City:
:: State: :: Zip:

Enter your entire New Mailing Address:

:: New Address:
:: New City:
:: New State:
:: New Zip:

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