Nonprofit Database Change Request
To:
PRICING AND CLASSIFICATION SERVICE CENTER PO BOX 3623 NEW YORK NY 10008-3623
Originating Post Office™ Postmaster Signature (by) Telephone (Include area code)
AUTHORIZATION NUMBER of Organization Roundstamp
Check action needed: Revocation Date Last Used ____/____/____ Name Change * Address Change
* Required documentation, such as an amendment to your articles of incorporation or letter from the IRS MUST be attached.
Old Name and Address Organization Name Street City, State, ZIP + 4®
New Name and Address Organization Name Street City, State, ZIP + 4
PS Form 6015, July 2005 (Page 1 of 1)