Tax 69 C Form – Fill Out and Use

Beer tax

Brine shrimp

Corporate/partnership

Fuel Taxes

Aviation fuel

Compressed natural gas

Environment assur. fee

Hydrogen

Liquefied natural gas

Motor fuel

Special fuel supplier

Gross receipts

Insurance premium

Mining severance

Oil & gas conservation

Oil & gas severance

Radioactive waste

Property Taxes

Centrally assessed

Railcar

Sales Taxes

E-911 emergency srvcs.

Energy

Locomotive Fuel

Lubricating oil

Multi-channel video/audio

Municipal telecom

MV rental tax

Prepaid disp. cell phones

Restaurant tax

Sales and use tax

Sexually explicit business

Transient room

Waste tire

Self-insurer’s

Tobacco, cigarette, e-cigarette

Withholding (employer)

Withholding mineral production

International Fuel Tax Agreement

Special Fuel User

Mark all that apply:

Corporate office / legal entity’s street address

Your business offices (if any).

Mailing address

The address you want to receive all written communications for this account.

Tax return mailing address

The address you want to receive tax returns, if different than your mailing address.

Outlet (for other changes, complete Section 5)

A physical location where you are licensed to make retail sales.

4 — Other Account Changes

TC-69C_2

5 — Outlet Changes and Closure

If changing more than one outlet, attach additional sheets in this format.

Current physical street address for this sales tax outlet

Phone

City

County

State

ZIP code





Close sales tax outlet	Closure date: ___________	Outlet number*: ______________
		*The outlet number is printed on the sales tax license.
Close transient room outlet	Closure date: ___________	Outlet number*: ______________
		*The outlet number is printed on the sales tax license.

TC-69C Instructions

TC-69C_i

Use this form to report changes to existing businesses already registered with the Tax Commission.

You can make most tax account changes online. Before filling out this form, see:

tap.utah.gov

Do not use this form to register a new business.

To register a new business, use from TC-69, or register online at:

tap.utah.gov or osbr.utah.gov

To register a new business location (outlet) for an existing sales tax account, use form TC-69B.

Get forms online at:

tax.utah.gov/forms

Section Instructions

Section 1 Fill out Section 1 completely.

In 1c, provide your business information as it was or is before the change you are reporting on this form. For example, if you are changing your business name, enter the old business name in Section 1.

Only report changes for one Utah account number on this form. If you need to report changes for multiple account numbers, submit separate copies of this form.

Section 2 Use Section 2 to report address changes. Mark the box matching the type of address you are changing.

If you are reporting a new address for an outlet that has moved, complete Section 5 and provide the address currently on file with the Tax Commission.

You cannot use this form to report a new outlet for a sales tax account. Use form TC-69B (Additional

Business Locations for a Sales Tax Account).

Section 3 Use Section 3 to close your tax account. If this account has outlets, all outlets will also be closed.

If you only need to close a single outlet for a sales tax account, complete Section 5.

Section 4 Use Section 4 to report all other account changes.

Section 5 Use Section 5 to report changes to single sales outlets, such as a closure or new phone number.

If changing more than one outlet, attach additional sheets in the same format.

Section 6 Sign and date. We will not process this form without an authorized signature.

Return this form to:

Exceptions Processing

Utah State Tax Commission

210 N 1950 W

Salt Lake City, UT 84134-3215

or fax to 801-297-7579.

___________________

If you need an accommodation under the Americans with Disabilities Act, email taxada@utah.gov, or call 801-297-3811 or TDD 801-297-2020. Please allow three working days for a response.