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Utah State Tax Commission |
TC-69C |
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210 N 1950 W • SLC, UT 84134 • tax.utah.gov |
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Notice of Change for a |
Rev. 11/21 |
Business and/or Tax Account
NOTE: You can make account changes online at tap.utah.gov.
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Submit a separate TC-69C for each Utah tax account number. |
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To register a NEW business, use tap.utah.gov (Tax Commission only), |
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osbr.utah.gov (multiple agencies) or form TC-69. |
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This section is required. Provide your CURRENT |
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1 – General Information |
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information on file with the Tax Commission. |
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1a. Social Security Number (SSN) |
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Federal Employer Identification Number (EIN) |
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(required for individual sole proprietor) |
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(required for all business types other than sole proprietor) |
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1b. Utah tax account number |
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1c. Name of Legal Entity - PRINT If you are a sole proprietor, write your name here |
Daytime phone number |
Cell phone number |
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Legal entity’s street address (before any changes) |
City |
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County |
State |
Foreign country (if not U.S.) |
ZIP Code |
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Legal entity’s mailing address (before any changes) |
City |
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County |
State |
Foreign country (if not U.S.) |
ZIP Code |
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Business website address (URL) |
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Email address |
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1d. Account type to change (mark only the accounts affected by this change; submit additional copies of this form as needed)
Beer tax
Brine shrimp
Corporate/partnership
Fuel Taxes
Aviation fuel
Compressed natural gas
Environment assur. fee
Hydrogen
Liquefied natural gas
Motor fuel
Special fuel supplier
Gross receipts
Insurance premium
Mining severance
Oil & gas conservation
Oil & gas severance
Radioactive waste
Property Taxes
Centrally assessed
Railcar
Sales Taxes
E-911 emergency srvcs.
Energy
Locomotive Fuel
Lubricating oil
Multi-channel video/audio
Municipal telecom
MV rental tax
Prepaid disp. cell phones
Restaurant tax
Sales and use tax
Sexually explicit business
Transient room
Waste tire
Self-insurer’s
Tobacco, cigarette, e-cigarette
Withholding (employer)
Withholding mineral production
International Fuel Tax Agreement
Special Fuel User
Mark all that apply:
Corporate office / legal entity’s street address
Your business offices (if any).
Mailing address
The address you want to receive all written communications for this account.
Tax return mailing address
The address you want to receive tax returns, if different than your mailing address.
Outlet (for other changes, complete Section 5)
A physical location where you are licensed to make retail sales.
NEW Address: _______________________________________
City, State, ZIP:_______________________________________
3 – Account Closure
•To close only a single sales outlet, use Section 5.
•Do not use this form to close a corporation. A corporation must withdraw or dissolve through the Utah Dept. of Commerce.
•You must file all tax returns for periods during which the account(s) was open.
Closure date: ________________ |
Close all accounts |
Continued on next page |
Closure date: ___________ Outlet number*: ______________
*The outlet number is printed on the sales tax license.
Closure date: ___________ Outlet number*: ______________
*The outlet number is printed on the sales tax license.
Closure date: ___________ License number: ______________
Closure date: ___________ License number: ______________
4 — Other Account Changes
4a. New phone number(s)
Day: ____________ Evening: ____________ Mobile: ____________
4b. Change or add email address:
The Tax Commission will send all electronic mail to this address. |
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New email address: _______________________________________ |
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4c. Change DBA/Business name: |
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DBA |
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Legal business name |
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Mark here and attach Dept. of Commerce Articles of Incorporation (not required for sole proprietors) |
New name: ___________________________________________ |
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4d. Add/remove officer/owner: |
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Mark here and attach Dept. of Commerce Change Form. |
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Add (name and address): |
___________________________________ |
SSN: ____________ |
Add (name and address): |
___________________________________ |
SSN: ____________ |
Add (name and address): |
___________________________________ |
SSN: ____________ |
Add (name and address): |
___________________________________ |
SSN: ____________ |
Remove:_______________________________________________
4e. Other – explain: _____________________________________________________________
_________________________________________________________________________
5 — Outlet Changes and Closure
If changing more than one outlet, attach additional sheets in this format.
•Use Section 5 to report CHANGES to EXISTING outlets.
•To add NEW SALES TAX or TRANSIENT ROOM outlets, use form TC-69B.
•To add NEW CIGARETTE, TOBACCO or E-CIGARETTE outlets, use form TC-69.
Current physical street address for this sales tax outlet
Close sales tax outlet
Close transient room outlet
Close cigarette/tobacco license outlet Close e-cigarette license outlet
Change phone number: ____________________________
Other: ___________________________________________________________________
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6 — Authorized Signature |
This form will be rejected without a signature. |
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SIGN HERE
Authorized Applicant or Owner |
Date |