Free TC-69C Notice of Change for a Tax Account - Utah

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Utah State Tax Commission 210 N 1950 W · SLC, UT 84134 · www.tax.utah.gov

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Notice of Change for a Tax Account
Read the instructions at the bottom of page 2 before filling out this form.

TC-69C
Rev. 4/09

1 -- General Information
1a. Social Security Number (SSN)
(required for individual sole proprietor) (required for all entities other than sole proprietor)

Federal Employer Identification Number (EIN)

1b. Existing Tax Account Number(s)
(required for all accounts)

Corporate Tax: Sales Tax: Withholding Tax: Mineral Prod. Withholding: 1c. Name of Business Entity or Sole Proprietor - PRINT
Owner's street address City County

C P T S T C W T H W M P
If you do not have a 14-character account number, enter your six-character account number.

Daytime phone number Cell phone number State ZIP code

2 -- Account Changes
2a. Close account (mark all that apply):
Sales tax

Mark all boxes that apply. Transient room tax Waste tire recycling fee Motor vehicle rental tax Mineral prod. W/H tax

Restaurant tax

Effective date: _____________ Withholding tax NOTE: Do not use this form to close a corporation. A corporation must withdraw or dissolve through the Utah Dept. of Commerce.

!

2b. Change address (mark all that apply):
Head office Physical location Mailing address
New address City

Corp. Tax

Sales tax

Withholding tax

Mineral prod. W/H tax

County

State

ZIP Code

2c. Change phone number (mark all that apply):

Corp. Tax

Sales tax

Withholding tax

Mineral prod. W/H tax

" "

!New phone number: ____________________________
Corp. Tax Sales tax Withholding tax Mineral prod. W/H tax

2d. Change email address (mark all that apply):

!New email address: ____________________________
Mark here and attach Dept. of Commerce Articles of Incorporation Mark here and attach Dept. of Commerce Change Form. · Provide the officer/owner's SSN: ____________________

2e. Change DBA/Business name: 2f. Add/remove officer/owner:

2g. Other:

Mark here and explain:

Continued on next page

3 -- Sales Tax Outlet Changes

Attach additional sheets in this format if necessary.

Use Section 3 of this form to report CHANGES to EXISTING sales tax outlets. To add NEW outlets, use form TC-69B.
Current physical street address for this sales tax outlet City County USTC assigned outlet number (printed on TC-62A & TC-62AG) State ZIP code

Close sales tax outlet Change phone number: Other:

Effective date:

Current physical street address for this sales tax outlet City County

USTC assigned outlet number (printed on TC-62A & TC-62AG) State ZIP code

Close sales tax outlet Change phone number: Other:

Effective date:

4 -- Authorized Signature
Signature of Authorized Applicant or Owner (Application will not be accepted without signature) Date

SIGN HERE

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Notice of Change for a Tax Account
Use this form to report changes for: · an existing corporate tax account · an existing withholding tax account · an existing sales tax account · existing outlets for a sales tax account · an existing mineral production withholding account To register a new business, use form TC-69. To report new outlets for an existing sales tax account, use form TC-69B. Section 4 Section 3 Section 2 Use Section 2 to report changes to your main tax account(s). Give complete information. Use Section 3 to report changes to single sales outlets/locations, such as closure or a new phone number. Sign and date. We will not process this form without an authorized signature.

Return this form to :

Instructions
Section 1 Fill out this section completely. This information identifies and confirms your tax account(s).

Master File Maintenance Utah State Tax Commission 210 North 1950 West Salt Lake City, UT 84134-3310 or fax to 801-297-3573