Form Tc-69c - Notice Of Change For A Tax Account
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Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 •
TC-69C
Notice of Change
Rev. 9/10
for a Tax Account
Read the instructions at the bottom of page 2 before filling out this form.
1 — General Information
1a. Social Security Number (SSN)
Federal Employer Identification Number (EIN)
(required for individual sole proprietor)
(required for all entities other than sole proprietor)
1b. Existing Tax Account Number(s)
(required for all accounts)
C P T
Corporate Tax:
S T C
Sales Tax:
Withholding Tax:
W T H
W M P
Mineral Prod. Withholding Tax:
F T X
Fuels Tax:
1c. Name of Business Entity or Sole Proprietor - PRINT
Daytime phone number
Owner's street address
Cell phone number
City
County
State
ZIP code
2 — Account Changes
Mark all boxes that apply.
2a. Change address
:
(mark all that apply)
Fuels tax
Corp. Tax
Sales tax
Withholding tax
Mineral prod. W/H tax
New address
Physical location
Mailing address
City
County
State
ZIP Code
2b. Change phone number
:
(mark all that apply)
Corp. Tax
Sales tax
Withholding tax
Mineral prod. W/H tax
Fuels tax
New phone number: _ _ _ _ _ _ _ __ _ _ _ _ __ __ _ _ __ _ _ _ _ _ _ _
2c. Change DBA/Business name:
Mark here and attach Dept. of Commerce Articles of Incorporation
2d. Add/remove officer/owner:
Mark here and attach Dept. of Commerce Change Form.
• Provide the officer/owner’s SSN: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2e. Other:
Mark here and explain: _ __ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ __
3 — Account Closure
Mark all boxes that apply.
Close account
:
Sales tax
Transient room tax
Motor vehicle rental tax
(mark all that apply)
Restaurant tax
Waste tire recycling fee
Mineral prod. W/H tax
Effective date: _ _ _ _ _ _ _ _ _ _ __ _
Withholding tax
Fuels tax
NOTE: Do not use this form to close a corporation. A corporation must withdraw or dissolve through the Utah Dept. of Commerce.
Continued on next page
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Parent category: Financial