Nebraska 22 Form PDF Details

The Nebraska 22 form is a crucial document for taxpayers within the state who need to report various changes related to their business operations or tax obligations. This comprehensive form, officially known as the Nebraska Change Request Form 22, serves several purposes, including updating name or address information for individual income tax purposes through Form 22A, modifying details on certificates, licenses, or permits issued by Nebraska, altering filing frequencies for tax returns, and reporting changes in business ownership or structure. Designed for a wide range of tax programs, from sales tax to lodging tax, this form ensures that taxpayer records are accurate and up to date. Filing this form is necessary when there is any change in the business's vital information, such as a move, a change in the federal employer ID number, or a shift in business classification code, among others. The document outlines clear instructions on how and when to file, what specific data is required -- including the Nebraska ID and federal employer ID numbers, details about the business location and classification, as well as any significant changes in tax program participation or business ownership. Additionally, it emphasizes the importance of accurately completing the form to avoid legal penalties, highlighting how these changes can impact the taxpayer's obligations and interactions with the Nebraska Department of Revenue. It's a tool not only for maintaining compliance but also for facilitating smooth operations for businesses navigating the complexities of tax administration in Nebraska.

QuestionAnswer
Form NameNebraska 22 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names Nebraska Change of Address Request FORM for Individual ...

Form Preview Example

7-104-1975 Rev. 9-2021 Supersedes 7-104-1975 Rev. 2-2021

Nebraska Change Request

Use Form 22A for individual income tax name/address changes.

FORM

22

1Nebraska ID Number

3County of Business Location in Nebraska (if applicable)

Please Do Not Write in This Space

2Federal Employer ID Number

4Business Classification Code

Name and Location Address

Name and Mailing Address

Names on your Certificate, License, or Permit

Names on your Certificate, License, or Permit

Address (Number and Street)

Street or Other Mailing Address

City

State

Zip Code

City

State

Zip Code

5Check All Tax Programs Affected by Request:

Sales Tax (01)

Retailer’s Use Tax (02)

Use Tax (04)

Prepaid Wireless Surcharge (19) Income Tax Withholding (21)

Fiduciary Income Tax (23)

Corporation Income Tax (24)

Financial Institution Tax (24)

Partnership Income Tax (25)

Severance and Conservation Tax (45)

Wholesale Cigarette Dealer (47) Tobacco Products (56)

Unstamped Cigarette Transporter (63)

Waste Reduction & Recycling Fee (64)

Tire Fee (66)

Litter Fee (67)

Lodging Tax (68)

Other

Indicate Type of Action Requested by Checking Appropriate Boxes Below

If you have a change in the ownership of your business, or have obtained a different federal employer ID number, you must cancel your certificates,

licenses, and permits. The new entity must file a Nebraska Tax Application, Form 20, to obtain its own certificates, licenses, and permits.

6

Cancellation

Date of Last Transaction

 

 

 

 

 

 

Location of Records

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Month _______ Day________ Year _______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reinstatement

Date of Reinstatement

 

Year the Account was

 

Location of Records

 

 

7

 

 

Cancelled

 

 

 

 

 

 

 

Month _____ Day _____ Year _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Returns are Presently Filed:

 

 

 

 

 

Request Permission to File Future Returns:

 

8

Change in

Monthly

Quarterly

 

 

 

Annually

 

Monthly

Quarterly

Annually

 

 

 

 

 

Filing Frequency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Annual Tax Liability

 

Average is Based on:

 

 

Number of Months Used to Compute Average

 

 

$

 

 

 

Estimate

Reported Amounts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

Change in Name and Address

If you are changing the names or addresses on your certificates, licenses, or permits (for example, due to a name change, relocation, or correction, and not from a change in ownership or federal ID number), please complete the following information.

New Name and Location Address of Business

 

New Name and Mailing Address

 

 

 

 

 

 

 

Name Doing Business As (DBA)

 

 

Name

 

 

 

 

 

 

 

 

Business Legal Name

 

 

 

 

 

 

 

 

 

 

Business Address (Number and Street)

 

 

Street or Other Mailing Address

 

 

 

 

 

 

 

City

State

Zip Code

City

State

Zip Code

10Is this a Nebraska location within the city limits?

 

 

 

11

 

Change in Officers, Members, or Partners (Attach list. See instructions.)

(1)

Yes

(2)

No

 

 

 

 

12Reason for Request

Under penalties of law, I declare that I have examined this request, and to the best of my knowledge and belief, it is correct and complete.

sign here

Signature of Owner, Partner, Member, Corporate Officer, or

Title

Date

Phone Number

Authorized Individual

 

 

 

 

 

 

 

Email Address

 

 

 

You may fax this request to 402-471-5927, or mail it to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.

revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729

Retain a copy for your records.

Instructions

Who Must File. A Form 22 should be filed by any taxpayer who:

Has a name or address change;

Needs to correct, cancel, reinstate, or change a Nebraska tax certificate, license, or permit;

Needs to change the filing frequency for sales and use tax, tire fee, lodging tax, or income tax withholding returns; or

Needs to report a change in officers, members, or partners of the business or organization.

One request may be used to correct, cancel, or change more than one certificate, license, or permit held by the taxpayer for the tax programs listed, provided the Nebraska ID number is the same. Nebraska Change of Address Request for Individual Income Tax Only, Form 22A, should be used for individual income tax name and address changes.

When and Where to File. Mail to the Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903, or fax to 402-471-5927, prior to the change.

Permanently Closing the Business. Form 22 should be filed to cancel one or more of the tax programs listed in line 5. You are required to file all tax returns for tax periods through the date of your last transaction, or the last wage payment made. This date is entered on line 6.

Employers who cancel their income tax withholding account should, within 30 days after discontinuing business, file a final Nebraska Reconciliation of Income Tax Withheld, Form W-3N, and attach the state copy of each Wage and Tax Statement, Federal Form W-2, issued to each employee.

Specific Instructions

Line 1. Enter the Nebraska ID number that you hold or have previously held. Do not enter your Social Security number.

Line 2. Enter your federal employer ID number, if you hold one. If one has been applied for, enter “Applied For.” If no federal employer ID number is held or applied for, enter your Social Security number.

Line 3. Enter the Nebraska county where your business is located. If located outside of Nebraska, enter “none”. See line 9 instructions if you are changing your location address.

Name and Address. Enter the name and address as last filed with the Nebraska Department of Revenue (DOR) or which is printed on your present certificate, license, or permit. If you are changing the name or address, the new name or address should be entered in the area immediately following line 9 of this request.

Line 5. Check the tax programs affected by this request. If there is a change in more than one program, check all appropriate boxes.

Line 6. A taxpayer closing a business must request cancellation of the tax program. A taxpayer having a seasonal type of business may request cancellation of the tax program for the period in which no business activity is conducted. Returns must be filed for all periods ending prior to the date of cancellation.

A change in ownership or type of ownership will require a new certificate, license, or permit. When possible, the Nebraska Tax Application, Form 20, used to obtain a new certificate, license, or permit, should accompany or precede this request for cancellation.

Line 7. A taxpayer who previously cancelled a tax program may have it reinstated provided no change in the business has occurred that would require a new certificate, license, or permit.

Line 8. A taxpayer filing a sales tax, use tax, or tire fee return with a tax liability of $900 to $3,000 annually may request a quarterly filing frequency. Those with a tax liability of less than $900 annually may request an annual filing frequency. Taxpayers filing a lodging tax return and remitting $99 or less of tax annually may request to file an annual return. Employers withholding less than $500 annually in state income tax may request to file an annual return, rather than quarterly returns.

Changes in filing frequency are not effective until the taxpayer receives approval from DOR. The taxpayer must complete and file all preidentified returns received for periods prior to the approval.

Line 9. Enter the new name and address. If your new location address is in a different county, enter the county in line 3 for your new location. The location address box cannot contain a PO Box Number; it must show the street address. If the taxpayer wants a return to be mailed to a preparer or another person, the name and mailing address should be completed to show this change.

Line 11. In order to keep your information current, please provide information on changes in officers, members, or partners, of your business or organization. Attach a complete list with the name, street address, email address, title, and Social Security number. Also, identify those that need to be removed and the effective date of the changes.

Line 12. Please provide a detailed explanation of the reason for this request. If there has been a change in ownership, give the name and address of the new owner.

Signature. This request must be signed by the owner, partner, member, corporate officer, or other individual authorized to sign by a power of attorney on file with DOR.

Email. By entering an email address, the taxpayer acknowledges that DOR may contact the taxpayer by email. The taxpayer accepts any risk to confidentiality associated with this method of communication. DOR will send all confidential information by secure email or by the State of Nebraska file share system. If you do not wish to be contacted by email, write “Opt Out” on the line labeled “email address.”

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1. Whenever filling out the Nebraska 22 Form, make certain to incorporate all of the essential blanks in their corresponding area. This will help to speed up the work, enabling your details to be processed quickly and accurately.

Nebraska 22 Form conclusion process described (part 1)

2. Soon after completing the last section, head on to the subsequent part and enter the necessary details in these fields - Cancellation, Date of Last Transaction, Location of Records, Month Day Year, Reinstatement, Date of Reinstatement, Year the Account was Cancelled, Location of Records, Month Day Year, Returns are Presently Filed, Request Permission to File Future, Change in Filing Frequency, Monthly, Quarterly, and Annually.

Completing section 2 of Nebraska 22 Form

Always be very mindful when completing Quarterly and Monthly, because this is where many people make some mistakes.

3. Completing sign here, Signature of Owner Partner Member, Title, Date, Phone Number, Email Address, You may fax this request to or, revenuenebraskagov NE and IA, Retain a copy for your records, and Rev Supersedes Rev is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling in segment 3 of Nebraska 22 Form

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