Form Tc-69 - Utah State Business And Tax Registration Page 2
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Section 1 – General Information
Required by all applicants.
1a. Organizational Structure
Must check one
Individual/Sole Proprietor
Limited Partnership
Corporation
S Corporation
(attach approval of election by IRS)
General Partnership
Limited Liability Partnership
Business Trust
Use two-letter state
:
Type of return the LLC will be filing with the IRS.
abbreviation throughout form.
1b. Incorporation Date
If a corporation enter the date:
and state:
of incorporation or qualification in Utah.
1c. Federal Identification Number
A sole proprietor is required to provide a Social Security Number (SSN). In addition, a sole proprietor with employees is required to also
provide an Employer Identification Number (EIN). All other organizational structures must provide an EIN.
Social Security Number (SSN)
Federal Employer Identification Number (EIN)
1d. Owner's Name - PRINT
Office Use Only
If the owner is a business entity, write the entity's registered name here
Daytime phone number
Owner's street address
City
County
State
Zip code
1e. DBA/Business Name
Business or trade name at this physical location
Business phone number
City/County Code
Physical street address of business (P.O. Box not acceptable)
City
County
State
Zip code
SIC Code
1f. Business Mailing Address
Write "same" if same as business location (1e)
USTC SIC
City
County
State
Zip code
1g. Business Description
Describe in detail the specific nature of your business
NAICS
If business is a restaurant, check the box that best describes your business:
Fast food
Family restaurant with liquor
Theme with liquor
White table cloth with liquor
Specialty food
1h. Officer/Owner Information
Provide the following information for each officer, general partner, managing member, trustee, or enterprise owner of the applying entity. Tax
Commission Rule R861-1A-15 requires the SSN of each individual and the EIN of each entity listed. To avoid unlawful disclosure, access to
account information is limited to those listed. If more space is needed, attach additional sheets. If changes occur, notify the Tax Commission.
Name and Title - PRINT
SSN / EIN
Home address and City/State/Zip
Telephone Number
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Parent category: Financial