tax forms found in
Tax Form Code
Tax Form Name

Nebraska Free Printable  for 2024 Nebraska Nebraska Change Request

Tax day has passed, and refunds are being processed! You can still e-file a late tax return here with TurboTax

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2023-nebraska-form-22.pdf, and you can print it directly from your computer.

Nebraska Change Request
Form 22

Nebraska Change Request FORM 22 Use Form 22A for individual income tax name/address changes. 1 Nebraska ID Number Please Do Not Write in This Space 3 County of Business Location in Nebraska (if applicable) 2 Federal Employer ID Number RESET FORM PRINT FORM 4 Business 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 5 Check All Tax Programs Affected by Request: Sales Tax (01) Fiduciary Income Tax (23) Wholesale Cigarette Dealer (47) Litter Fee (67) Retailer’s Use Tax (02) Corporation Income Tax (24) Tobacco Products (56) Lodging Tax (68) Use Tax (04) Financial Institution Tax (24) Unstamped Cigarette Transporter (63) Other Prepaid Wireless Surcharge (19) Partnership Income Tax (25) Waste Reduction & Recycling Fee (64) Income Tax Withholding (21) Severance and Conservation Tax (45) Tire Fee (66) 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 Date of Last Transaction Cancellation Location of Records Month________ Day_________ Year _______ 7 Reinstatement Date of Reinstatement Location of Records ear the Account was Y Cancelled Month _____ Day _____ Year _____ Returns are Presently Filed: 8 Change in Filing Frequency Monthly Request Permission to File Future Returns: Quarterly Average Annual Tax Liability Annually Quarterly Average is Based on: $ 9 Monthly Estimate Annually Number of Months Used to Compute Average Reported Amounts 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) City Street or Other Mailing Address State Zip Code City 10  Is this a Nebraska location within the city limits? (1) Yes 12  Reason for Request sign here 11 (2) No State Zip Code Change in Officers, Members, or Partners (Attach list. See instructions.) 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. Signature of Owner, Partner, Member, Corporate Officer, or Authorized Individual Title Date Phone Number 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 7-104-1975 Rev. 9-2021 Retain a copy for your records. Supersedes 7-104-1975 Rev. 2-2021 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.”
Extracted from PDF file 2023-nebraska-form-22.pdf, last modified September 2021

More about the Nebraska Form 22 Other TY 2023

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

We last updated the Nebraska Change Request in January 2024, so this is the latest version of Form 22, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 22 directly from TaxFormFinder. You can print other Nebraska tax forms here.

eFile your Nebraska tax return now

eFiling is easier, faster, and safer than filling out paper tax forms. File your Nebraska and Federal tax returns online with TurboTax in minutes. FREE for simple returns, with discounts available for TaxFormFinder users!

File Now with TurboTax

Related Nebraska Other Forms:

TaxFormFinder has an additional 34 Nebraska income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Nebraska Form 22.

Form Code Form Name
Form 2210N Individual Underpayment of Estimated Tax
Form 2220N Corporation Underpayment of Estimated Tax
Form 22A Nebraska Change Request for Individual Income Tax Use Only

Download all NE tax forms View all 35 Nebraska Income Tax Forms

Form Sources:

Nebraska usually releases forms for the current tax year between January and April. We last updated Nebraska Form 22 from the Department of Revenue in January 2024.

Show Sources >

Historical Past-Year Versions of Nebraska Form 22

We have a total of six past-year versions of Form 22 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

TaxFormFinder Disclaimer:

While we do our best to keep our list of Nebraska Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/nebraska/form-22