Form Tc-69c - Notice Of Change For A Business And/or Tax Account
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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. 5/12
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
Motor fuel
Rail car
Restaurant tax
Brine shrimp
Special fuel supplier
Sales Taxes
Sales and use tax
Corporate/partnership
Gross receipts
E-911 emergency srvcs.
Sexually explicit business
Fuel Taxes
Insurance premium
Energy
Transient room
Aviation fuel
Mining severance
Lubricating oil
Waste tire
Compressed natural gas
Oil & gas conservation
Multi-channel video/audio
Self-insurer’s
Environment assur. fee
Oil & gas severance
Municipal telecom
Tobacco
Liquefied natural gas
Radioactive waste
MV rental tax
Withholding (employer)
Prepaid disp. cell phones
Withholding mineral production
2 – Address Change
Mark all that apply:
Business headquarters
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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