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Closed or Sold Business Affidavit
Closed or Sold Business Affidavit
Business Name
Business Account Number
Owned by
If you do not have the Federal Employer Identification Number (FEIN), check here
.
Federal Employer Identification Number (FEIN)
Business Location Address 1
Business Location Address 2
City
State
ZIP Code
Date ceased doing business at this location
Please provide your forwarding address.
Address 1
Address 2
City
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP Code
By signing this affidavit, the owner of the above named business attests to the fact that said applicant has been lawfully conducting a business in Stafford County, Virginia and has sold or closed the business. Details of this sale or closure are as follows:
Sold business with all assets and business will remain open under different name and / or ownership. (Must report new owners name and phone numbers)
Business closed and all assets removed from premises.
Business and all assets moved to another location.
Please provide the new business address
New Business Location Address 1
New Business Location Address 2
City
State
ZIP Code
Please provide the new owner(s) information
First Name
Last Name
Phone
Contact Phone
Email Address
Signature
(Enter your full name)
Title