Form Tc-69c - Notice Of Change For A Business And/or Tax Account - 2015
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Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 • tax.utah.gov
TC-69C
Notice of Change for a
Rev. 8/15
Business and/or Tax Account
NOTE: You can make account changes online at taxexpress.utah.gov.
To register a NEW business, use form TC-69 or go to osbr.utah.gov.
Submit a separate TC-69C for each Utah tax account number.
This section is required. Provide your CURRENT
1 – General Information
information on file with the Tax Commission.
1a. Social Security Number (SSN)
Federal Employer Identification Number (EIN)
(required for individual sole proprietor)
(required for all business types other than sole proprietor)
1b. Utah tax account number
Daytime phone number
1c. Name of Business Entity or Sole Proprietor - PRINT
Owner's street address (before any changes)
Cell phone number
City
County
State
ZIP code
1d. Account type to change
(mark only the accounts affected by this change; submit additional copies of this form as needed)
Beer tax
Special fuel supplier
Sales Taxes
Sales and use tax
Brine shrimp
Gross receipts
E-911 emergency srvcs.
Sexually explicit business
Corporate/partnership
Insurance premium
Energy
Transient room
Fuel Taxes
Mining severance
Lubricating oil
Waste tire
Aviation fuel
Oil & gas conservation
Multi-channel video/audio
Self-insurer’s
Compressed natural gas
Oil & gas severance
Municipal telecom
Tobacco, cigarette, e-cigarette
Environment assur. fee
Radioactive waste
MV rental tax
Withholding (employer)
Hydrogen
Property Taxes
Prepaid disp. cell phones
Withholding mineral production
Liquefied natural gas
Centrally assessed
Restaurant tax
Motor fuel
Railcar
2 – Address Change
Mark all that apply:
Corporate office / owner’s street address
Tax return mailing address
The physical location of your business offices (if any).
The address you want to receive tax returns, if
different than your general mailing address.
Mailing address
The address you want to receive all written
Storefront location (outlet)
communications for this account.
A physical location or outlet where you are licensed to
make retail sales. Also complete Section 5.
N EW Address: _ _ _ _ _ _ __ _ _ _ __ _ _ __ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City, State, ZIP: _ _ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
3 – Account Closure
Clear form
Closure date:
_ _ _ _ _ _ _ _ __ _ _ _ __ _
• 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.
Continued on next page
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