Transcription of KANSAS DEPARTMENT OF REVENUE FOR OFFICE USE ONLY …
1 NOTICE OF TAX ACCOUNT CLOSUREKANSAS DEPARTMENT OF REVENUE CUSTOMER RELATIONSPO BOX 3506 TOPEKA, KANSAS 66625-3506 PHONE: 785-368-8222 FAX: Tax Account Employer s ID Telephone s Telephone Mailing AddressCityStateZip s/Officer s AddressCityStateZip Code9. Effective, I wish to cancel my registration for the following tax(es). Check each box that applies and enter the specific account number for that tax SalesRetailers CompensatingLiquor EnforcementLiquor DrinkConsumer s UseTire ExciseFOR OFFICE USE ONLYI nactive:_____Date/InitialAudited:_____Da te/InitialDeleted:_____Date/Initial_____ _____ Bingo Enforcement_____ _____ Dry Cleaning Surcharge_____ _____ Withholding_____ _____ Transient Guest Tax_____ _____ Vehicle Rental Tax_____ _____ Water Protection Fee_____10. Does this business currently have employees?Ye sNo If no, enter effective date:_____11. Has there been a transfer or a change in ownership?NoYes If yes, complete lines a, b and c:a.
2 Trade name of new business_____b. New owner s name_____c. Starting date of new business_____Taxpayer ID This business hasa cash bondan escrow bonda surety bondno bondunknown 13. Have all applicable forms for the taxes marked above been filed to date of closing?Ye sNo If no, file them with this If this is a consolidated registration, are all locations being closed?Ye sNo If no, list the specific locations to be closedunder Remarks on line Remarks and final settlement or arrangement for settlement:_____SIGNHERE_____(Signature of Retailer/Employer)(Printed Name of Retailer/Employer)(Title)(Date)_____(Sig nature of Preparer) (Printed Name of Preparer)FOR OFFICE USE ONLYWas the date that the business was discontinued estimated? No YesIf yes, give source of information:_____Accounts receivable remain to be collected: No Yes If yes, tax type:_____Mailing address:_____A Jeopardy Assessment is recommended. No Yes If yes, tax type:_____A warrant is recommended.
3 No YesIf yes, tax type:_____Comments:_____Prepared by:_____Date:_____CR-108 (Rev. 8-19)301618
