Collection Information For Businesses
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4Utah State Tax Commission
210 North 1950 West - Salt Lake City - Utah 84134 - Telephone (801) 297-2200
TC-803
Rev. 1/96
Collection Information For Businesses
1.
Name and Address of Business
2.
Business Telephone Number
3. (Check appropriate box)
Sole Proprietor
Other (specify)
Partnership
Corporation
4. Name and Title of Person Interviewed
5. Account Number:
6. Type of Business
Sales
Withholding
Other
7. Information about Owner, Partners, Officers, etc.
Effective
Telephone
Social Security
Name and Title
Total Shares
Home Address
Date
Number
Number
Section One: General Financial Information
Tax Year Ended
Form
Net Income Before Taxes
8. Latest Filed Income Tax Return
Bank Accounts (List all types of accounts including payroll and general, savings, certificates of deposit, etc.)
Type of
Account
Name of Institution
Balance
Address
Number
Account
$
9. Total (Enter in item 16)
Bank Credit Available (Lines of credit, etc.)
Credit
Amount
Credit
Monthly
Name of Institution
Address
Limit
Owed
Available
Payment
$
$
$
$
10. Totals (Enter in Items 23 or 24 as appropriate)
FORM TC803A 1/96
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Parent category: Financial