Indiana Indiana Business Closure Request

Indiana Business Closure Request	
BC-100
BC-100

Indiana Department of Revenue

Indiana Business Tax Closure Request

State Form 52038
(R14 / 7-24)

	

TID Number: 	

	

FID Number:

Location Number:

Owner Name

Corporation Name

Address
City

State

ZIP

I certify that I have been out of business or I am no longer required to be registered for the indicated tax type.
I understand that I (or another responsible officer if applicable) am required to file and remit a tax return for the tax account(s) and tax
period(s) up to and including the closed date.

	Sales 	

Withholding 	

	Date	

	Other

		

FAB

Date	

Date

Date

I further certify no tax of the above listed nature has been collected since the above date.
I may also be responsible for all liabilities or unfiled returns proven to be due and owed at a later date.
A responsible officer listed in our system or on the account must sign the BC-100 to close any business tax types.
Signature:	Date:
Printed Name:	Title:	

Daytime Telephone Number:

This is a change of legal mailing address for the above listed closed tax account.
Please forward any final correspondence regarding this account to the following address:
Address:
City, State, and ZIP Code:

Questions regarding the completion of this form may be directed to the Indiana Department of Revenue at 317-232-2240.
Mail the completed form:
Indiana Department of Revenue
Tax Administration Processing
P.O. Box 6197
Indianapolis, IN 46206-6197

Fax the completed form:
317-232-1021
Complete the form online:
intime.dor.in.gov