Shown is a completed Form 2209-A which highlights completed fields numbered 1 through 12. See Figure 3.17.80-25 for explanation of completed/numbered fields.Name of taxpayer (Name used on Form 2209)Address as shown on Form 2209New Address, if differentDate of form 2209Date of this reportIdentifying number (taxpayer's TIN)Address of Area Office indicated on Original Form 2209Payment 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 2209, etc.)Address of office making report