Shown is a completed Form 2209–A and highlights the completed fields numbered 1 through 12 (see Figure 3.17.80–18b that identifies the fields). The following list describes the completed/numbered fields in Figure 3.17.80-18aName of taxpayer (Name used on Form )Address as shown on Form New Address, if differentDate of form Date of this reportIdentifying number (taxpayer TIN)Address of Area Office indicated on Original Form Payment received and date (if applicable)Information or documents necessary for completion (if applicable) Additional information requested as indicated under RemarksRemarks (e.g. for additional follow-up, recalling original Form , etc.)Address of office making report