Form Tc-69 - Utah State Business And Tax Registration Page 7
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8Section 12 – Cigarette and Tobacco
12a. When will you start selling or making purchases?
Month
Day
Year
12b. Business Activities
Check each box where your answer is "yes." Notify the Tax
Commission if any of the information changes.
USTC Use Only
1. Will you purchase tobacco products (shisha; moist snuff; RYO, pipe and chewing tobacco; snus; etc.)
1.
distributor
tax-free for sale in Utah?
2.
stamper
• Bond required. Check “Tobacco Products Distributor” on page 1 (1a) and
3.
retailer
attach bond.
4.
e-cig/retail
The cash or surety bond value must equal your estimated quarterly tobacco products tax
($500 minimum). The Tax Commission may require you to increase your bond if your actual
5.
PM mfg
tax is greater than the estimated amount.
6.
NPM mfg
Estimate your tobacco products tax for a quarterly reporting period:
7.
RMO
$_ ___ __ __
8.
PACT
2.
Will you purchase unstamped cigarettes and affix a Utah stamp prior to sale or distribution?
• Bond required. Check “Cigarette Stamper” on page 1 (1a) and attach bond.
The minimum value of the cash or surety bond is $500.
Note: Unpaid cigarette stamp purchases may not exceed 90 percent of your bond value.
3.
Will you make retail sales of cigarettes and/or tobacco products (RYO tobacco, shisha, moist snuff, etc. )?
• Signed & notarized affidavit required if:
a) you are not required to post a bond (see questions 1 and 2, above), AND
b) you will sell ONLY stamped cigarettes (no other tobacco products).
The affidavit must state that you will only sell stamped cigarettes.
4.
Will you sell electronic cigarettes or electronic cigarette substances?
5. Are you a Participating Manufacturer of cigarettes or RYO tobacco?
6.
Are you a Non-participating Manufacturer of cigarettes or RYO tobacco?
7.
Will you operate a cigarette rolling machine in Utah?
• Certification required. Attach form TC-550.
8.
Are you subject to the PACT Act and will you ship cigarettes and/or tobacco products into Utah from another state or country?
Multiple Locations: If you will sell cigarettes, e-cigarettes and/or tobacco products (including vending machine sales) from more than
one fixed Utah location, file a separate TC-69 for each business location including the $30 for each location.
See Pub 65, Tax Information for Retailers, Distributors and Stampers of Cigarettes and Tobacco Products
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Section 13 – Beer
Only complete section 13 if you are a business located in Utah. If you’re an out-of-state supplier with no Utah presence, submit form TC-69N.
13a. When will you start manufacturing or distributing beer in Utah?
Month
Day
Year
13b. Business Type
Check all that apply.
1.
Beer manufacturer
2.
Beer distributor
Page 7
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