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Click ‘Get Form’ to open it in the editor.
Begin by entering your Federal Employer Identification Number in the designated field. This is crucial for identification purposes.
Next, input your Central Registration Number. This helps ensure that your submission is processed correctly.
Indicate the date if your business has been permanently discontinued. This information is vital for accurate record-keeping.
Fill in your Employer Name and Street Address, along with the City, State, and ZIP Code +4. Ensure all details are correct to avoid delays.
If applicable, provide the Purchaser’s Name and Address if you have sold your business, followed by the Date Sold.
Complete the section for the Person Completing this Form, including their Telephone Number and Email Address for any follow-up communication.
Finally, ensure that a Responsible Official signs the form before submission. This validates your document.

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