Form Tc-69n - Utah State Tax Registration For Out-Of-State Beer Distributors

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TC-69N
Utah State Tax Registration for Out-of-State Beer Distributors
Rev. 2/12
General Instructions
Utah State Tax Commission
210 North 1950 West
• Type or print clearly.
Salt Lake City, UT 84134-3310
801-297-2200
• Submit this form if you are a wholesaler or distributor outside Utah with no Utah presence.
1-800-662-4335
If you are a Utah-based company or have a presence in Utah, submit form TC-69
Fax: 801-297-3573
• Mail or fax the completed form to the Tax Commission (address and fax number at right).
tax.utah.gov
Section 1 – General Information
1a. Organizational Structure
Check one.
Individual
Government
Corporation
Partnership
LLC/Trust
 Sole Proprietor
 Federal
 C Corp
 General
 LLC
 Low Profit LLC
 State
 S Corp
 Limited
Check the return the LLC files with the IRS
 Corp.
 Part.
 Tribal
 Non-profit
 Limited Liability
 Political Subdivision 
 Single Member LLC
Check the return the LLC files with the IRS
 Indiv.
 Corp.
 Part.
 Trust
Check the return the Trust files with the IRS
 Fiduc.
 Corp.
 Part.
1b. Federal Identification Number
Every sole proprietor must provide a Social Security Number (SSN). All other organization types must provide an EIN.
Social Security Number (SSN)
Federal Employer Identification Number (EIN)
1c. Name of Business Entity - PRINT
If you are a sole proprietor, write your name here
Daytime phone number
Owner's street address
Cell phone number
City
County
State
Foreign country (if not U.S.)
ZIP Code
Business website address (URL)
1d. DBA/Business Name
Business or trade name at this physical location
Physical street address of business (P.O. Box not acceptable)
Business phone number
Fax number
City
County
State
ZIP Code
Foreign country (if not U.S.)
1e. Business Mailing Address
Email address
City
State
ZIP Code
Foreign country (if not U.S.)
Contact phone number
1f. Contact Person
Name
Title
Street address
Email address
City
State
ZIP Code
Foreign country (if not U.S.)
Phone number
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