Change of Address Form for Social Security
Your Signature Date Spouse’s Signature (if joint return) Date
If Part II completed: Signature of Owner, Offi cer, or Representative Date Title
Daytime Telephone Number (optional)
( )
Form CT-8822
Change of Address
Complete in blue or black ink only. This form can be fi led electonically; see instructions on reverse. Do not attach this form to your return.
Department of Revenue Services
State of Connecticut
PO Box 2937
Hartford CT 06104-2937
(Rev. 3/08)
3a. Your First Name, Middle Initial, and Last Name 3b. Your Social Security Number
4a. Spouse’s First Name, Middle Initial, and Last Name 4b. Spouse’s Social Security Number
5. Prior Name(s): See instructions.
6a. Your Old Address (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Apt. No.
6b. Spouse’s Old Address, if different from Line 6a (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Apt. No.
7. New Address (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Apt. No.
8. Effective Date of Address Change 9. Reason for Address Change
Check all boxes this change affects:
1. Connecticut individual income tax returns (Forms CT-1040, CT-1040EZ, and CT-1040NR/PY)
If your last return was a joint return and you are now establishing a residence separate
from the spouse with whom you fi led that return, check here. . ............................................................................
2. Connecticut estate and gift tax return (Form CT-706/709)
Part I Complete This Part to Change Individual Income Tax, Estate Tax, and Gift Tax Address Information
Part II Complete This Part to Change Business Mailing Address or Business Location
Check all boxes this change affects:
10. Other income tax returns (Form CT-1041, Form CT-1065/CT-1120SI, etc.)
11.
Business returns (Form OP-424, Form OS-114, etc.)
12.
Business location
13a. Business Name 13b. Connecticut Tax Registration Number 13c. Federal Employer ID Number
14. Old Mailing Address (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Room or Suite No.
15. Old Business Location (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Room or Suite No.
16. New Mailing Address (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Room or Suite No.
17. New Business Location (No., Street, City or Town, State, and ZIP Code). If a PO Box or foreign address, see instructions. Room or Suite No.
18. Effective Date of Address Change 19. Reason for Address Change
Please
Sign
Here
Part III Signature
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