Change Of Name Address Form
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Change Of Name Address Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
Tags: Change Of Name Address Form, MF-629, Indiana Statewide, Department Of Revenue
(R / 12-08)
Indiana Department of Revenue
Change of Name/Address Form
Do not use this form to report changes in ownership.
Check all that apply:
Previous Name and/or Address
New Name and/or Address
Please provide all license numbers to which the above change applies:
Special Fuel License Number:
Gasoline Distributor's License Number:
Indiana Prepaid Sales Tax License Number:
Typed or Printed Name:
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