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Your information will be shared, if applicable, with the following Washington State programs:

  • Business Licensing (Business Licensing Service)
  • Unemployment Insurance Account (Employment Security)
  • Workers Compensation Insurance Account (Labor & Industries)
  • State Tax Account (Dept. of Revenue)

If you have licenses or permits with cities, counties, or other state agencies, you must contact them directly to close your account. Your account will be updated with the Department of Revenue within 5 business days.

UBI/Tax Registration Number
Name of Business
Name of Person completing this form
E-mail Address of Person completing this form
Date Business Closed 
 /  /  Calendar Pop-Up (Example: MM/DD/YYYY, 01/14/2002)* 

Current Mailing Address

Current Telephone Number
()   -  ext.   (Example: (555) 555-5555 ext. 5555)

Business E-mail Address

If You Sold Your Business
New Owner

New Owner's UBI/Tax Registration Number

The telephone number and e-mail address information will not be given to anyone without taxpayer's permission or specific statutory authority.