Form Tc-69 - Utah State Business And Tax Registration Page 3
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82i. Business Description
Describe the nature of your business in detail (include the types of products sold)
Restaurant: If your business is a restaurant, check the box that best describes you:
Fast food
Family restaurant with liquor
Theme with liquor
White table cloth with liquor
Specialty food
2j. Officer/Owner Information
Enter the following information for each officer, general partner, managing member, trustee or enterprise owner. You must provide the SSN of
each individual and the EIN of each entity listed (Tax Commission Rule R861-1A-15). The Tax Commission will only discuss account
information with those listed. Attach additional sheets if you need more space. Notify the Tax Commission if any changes occur.
Name and Title - PRINT
SSN and EIN
Home Address and City/State/ZIP
Phone Number
SSN
EIN
SSN
EIN
Section 3 – Employer Withholding
3a. When will you start paying wages?
3b. Estimate the amount of Utah wages you expect
to pay in a calendar year:
Month
Day
Year
$16,000 or less
$16,001 - $200,000
$200,001 or more
3c. Annual Filing Option
Will you file employment taxes on Schedule H of your federal income tax return (Form 1040)?
Yes
No
Will you file form 944, Employer’s Annual Federal Tax Return ?
Yes
No
If yes, attach a copy of the IRS notification letter authorizing annual filing.
Section 4 – Mineral Production Withholding
4a. When did you start making mineral production payments?
Month
Day
Year
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Section 5 – Insurance Premium
5a. Are you an admitted insurer who is required to pay tax on premiums received from direct business in Utah? If yes,
when did you start writing insurance in Utah?
Month
Day
Year
Section 6 – Self-Insurer
6a. Are you a self-insured employer? If yes, when did you begin self-insuring in Utah?
Month
Day
Year
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