DSA Tax - Notice of Change

NOTICE OF CHANGE FORM

Name
DSA Membership #
Choose one of the following change categories. If you have a change to more than one, submit additional change forms...
What category of asset did you buy or sell
Item Purchased Description	Date	Price	How


Item Sold Description	Date	Price	How


If you leased this item, what is your monthly payment?
If you took out a loan for this item, please provide:
loan date
original amount
number of payments
payment amount
interest rate
If the interest rate is variable, please describe the variable terms:

If you chose "other" in any of the boxes above, please explain:

For a version of this form to print and fax see the PDF Forms Index