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Reg C-L / Reg C-EA Change of Registration Information

Information (must be completed to process this form)FEIN _____Name _____Address TO IDENTIFICATION INFORMATIONFEIN-Reason for Change of FEIN _____Business NameTrade NameBusiness Location: (Do not use P. O. Box for location address)Street _____City _____ StateZip CodeMailing Name and Address:Name _____Street _____City _____ StateZip Code - (Give 9-digit Zip)STATE OF NEW JERSEY - DIVISION OF REVENUEREQUEST FOR Change OF Registration INFORMATIONREG-C-L(8-05)Use this form to report any Change in filing status, business activity, or to Change your identification Information such as identification number,business and/or trade name, business address, mailing address, etc.

II. LINE BY LINE REQUIREMENTS FOR BUSINESS AMENDMENT FILING (REG-C-EA) A. Business Name and NJ 10-digit ID number- List the Business Entity name as currently reflected on the State’s public records system and the NJ 10-digit ID number.

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