Utah State Application For Ifta Sfu And Irp Tc69mc Page 2
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Section 2 - Organizational Structure
2a. Federal Identification Number
All organizational structures must provide an EIN. In addition, a sole proprietor is required to provide a Social Security Number (SSN).
Social Security Number (SSN)
Federal Employer Identification Number (EIN)
U.S. DOT Number
e
2b. Must check on
Check the return type the LLC or
Corporation
Partnership
LLC/Trust
Individual
Trust files with the IRS
Sole proprietor
C Corp
General
LLC
Corp.
Part.
S Corp
Limited
Low Profit LLC
Corp.
Part.
Non-profit
Limited Liability
Single Member LLC
Corp.
Part.
Indiv.
Trust
Indiv.
Corp.
Part.
2c. Organization date: Enter the date of qualification or incorporation in Utah: __________________
Tax year end date: __________________
Department of Commerce entity number: Enter number issued by the Department of Commerce: __________________
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
Office Use Only
City
County
State
ZIP code
Business website address (URL)
County Code
DBA/Business Name Business or trade name at this physical location
Business phone number
SIC Code
Physical street address of business (P.O. Box not acceptable)
Fax phone number
City
State
ZIP code
County
NAICS
Business Mailing Address Write "same" if same as business location
E-mail address
City
State
ZIP code
Contact phone number
Business Description Describe in detail the specific nature of your business
2d. Officer/Owner Information
Provide the following information for each officer, general partner, managing member, trustee, or enterprise owner of the applying entity.
SSN of each individual and the EIN of each entity listed
Tax Commission Rule R861-1A-15 requires the
. 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.
Telephone Number
Name and Title - PRINT
SSN or EIN
Home address and City/State/ZIP
SSN
EIN
SSN
EIN
SSN
EIN
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Parent category: Financial