Utah Form Tc 69 – Fill Out and Use This PDF

UTAH STATE BUSINESS AND TAX REGISTRATION

TC-69

Rev. 6/13

General Instructions

•Read the instructions carefully. Type or print clearly. Incomplete or illegible registration forms will be rejected.

•Mail or fax the completed form to the Tax Commission (address and fax number at right).

•Allow us 15 business days to process this form. For faster processing, register online at osbr.utah.gov.

•Contact the proper city or county for business licensing requirements.

Utah State Tax Commission

210 North 1950 West

Salt Lake City, UT 84134-3310

801-297-2200

1-800-662-4335

Fax: 801-297-3573

tax.utah.gov

1a. Check each box that applies		Fee	Complete Sections
	Employer Withholding License	No Fee	2, 3, 14
	Mineral Production Withholding	No Fee	2, 4, 14
 Sales and Use Tax License		No Fee	2, 7, 14

Cable operator or multi-channel video

	or audio service provider	No Fee	2, 7, 14
	Beer Tax (distributor/manufacturer only)	No Fee	2, 13, 14
	Insurance Premium	No Fee	2, 5, 14
	Self-Insured Employer	No Fee	2, 6, 14
	Payroll Service Withholding Submitter	No Fee	2, 14
 Submitter or 3rd Party Preparer		No Fee	2, 14
	Cigarette and Tobacco License	$30 per location	2, 12, 14
	(make check payable to Utah State Tax Commission)
	 Cigarette Stamper	License and Bond†	2, 12, 14
	 Tobacco Products Distributor	License and Bond†	2, 12, 14
Out of State Cigarette/Tobacco PACT Act		No Fee	2, 12, 14
	Delivery Shipper
Natural Gas or Electricity Purchases for		No Fee	2, 7, 14
	Resale or Transportation

USTC Use Only

†You must provide a bond for cigarette stamping and tobacco wholesale distribution (see Section 12 for details).

Get a surety or performance bond from an insurance company. Attach the bond to this form, or forward the bond after submitting the form.

Section 2 – General Information

Required by all applicants.

2f. 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)

2g. DBA/Business Name Business or trade name at this physical location (for additional outlets, fill out form TC-69B)

Physical street address of business (P.O. Box not acceptable)			Business phone number	Fax number
City	County	State	Foreign country (if not U.S.)	ZIP Code

Required: Local Utah government issuing this location’s business license

Lodging services: Will you provide motel, hotel, trailer court, campground or other lodging services at this location?

Yes	No
Cigarette/tobacco: Check all boxes that describe your cigarette/tobacco activities at this location (see section 12b for definitions):
Retailer	 Stamper	 Distributor		 Importer	 PM Mfg			 NPM Mfg		 PACT Act shipper
2h. Business Mailing Address							Email address
City			State	ZIP Code		Foreign country (if not U.S.)				Contact phone number

USTC Use Only

SIC Code

USTC SIC

NAICS

3a. When will you start paying wages?

Month Day Year

3c. Annual Filing Option

3b. Estimate the amount of Utah wages you expect to pay in a calendar year:

$16,000 or less

$16,001 - $200,000

$200,001 or more

7a. When will you start selling or making purchases?

Month Day Year

7c. If you have a Streamlined Sales Tax (SST) number, enter it here:

7b. Estimate your annual net sales and purchases subject to tax.

$16,000 or less

$16,001 - $800,000

$800,001 - $1,500,000

$1,500,001 or more

Check this box to voluntarily file monthly: 

7d. Are you a cable operator or multi-channel video or audio service provider with no Utah sales tax liability?

Yes No If yes, skip 7e.

7e. Sales and Use Tax

Check each box where your answer is "yes." Notify the Tax Commission if any of the information changes.

1.Will you sell goods or services from only one fixed Utah business location (includes vending machine operators and door-to-door sellers with only one warehouse)?

2.Will you sell goods or services from more than one fixed Utah business location (includes vending machine operators and door-to-door sellers with more than one warehouse)?

•If yes, complete and attach form TC-69B, listing each business location.

3. Will you do one or both of the following:

a.sell goods or services that are shipped from outside Utah to a Utah customer(s)?

b.have goods or materials delivered from outside Utah to a location(s) in Utah other than your fixed place of business?

4. Will you do multi-level marketing?

•If yes, we will send you a Multilevel Marketing Agreement once we have reviewed and processed your application.

5. Will you charge admission or fees for any entertainment, recreation, exhibition, cultural or athletic activity

provided somewhere other than your business location?

6.Will you provide services (cleaning, washing, dry cleaning, repairing or renovating tangible personal property) at non-fixed places of business and not sell tangible personal property?

7.Will you receive recurring payments for leases or rentals of tangible personal property or services?

8.Are you a seller with no physical or representational presence in Utah who is selling goods or services

shipped direct by U.S. mail or common carrier to Utah customers? See Pub 37, Business Activity and Nexus in Utah.

9.Will you sell grocery food? See Pub 25 for the definition of grocery food.

10.Will you sell motor vehicles, aircraft, watercraft, manufactured homes, modular homes or mobile homes in a city or town with the resort communities tax?

The resort communities tax applies to: Alta, Boulder, Brian Head, Bryce Canyon, Garden City, Green River, Independence, Kanab, Midway, Moab, Orderville, Panguitch, Park City, Park City East, Springdale and Tropic

11.Are you a utility providing telephone service, electricity or gas?

•If yes, complete and attach form TC-62Q.

12.Will you have retail sales of new tires? This includes new tires sold as part of a vehicle sale, new tires bought

on or for rented vehicles, and new tires bought from anyone not collecting the Waste Tire Recycling Fee.

13.Will you provide motel, hotel, trailer court, campground or other lodging services for less than 30 consecutive days?

14.Are you a restaurant? See Pub 25 for the definition of restaurant.

15.Will you rent motor vehicles (12,000 pounds or less) to customers for 30 days or less?

16.Will you sell residential fuels (electricity, heat, gas, coal, fuel oil, firewood and other fuels for residential use)?

17.Will you purchase goods or services tax-free from outside Utah that you or your business will store or use

in Utah? See Pub 25 for the definition of use tax.

18. Are you a municipality that generates your own taxable municipal energy,

-OR- do you estimate you will collect municipal energy tax of over $1 million annually?

19.If you did not mark question 18, will you sell taxable municipal energy?

20.Do you provide only the transportation component of taxable energy delivered to the point of sale or use?

21.Will you sell disposable cell phones or disposable cell phone minutes?

22.Will you be the first seller in Utah of lubricating oil in packages of less than 55 gallons?

23.Are you a cable operator or a multi-channel video or audio service provider?

24.Are you a sexually explicit business (see Utah Code §59-27-102)?

25.Will you provide telecommunication services to end consumers?

26.Are you a telephone line provider (radio, land line, VOIP, etc.)?

USTC Use

Only

7d. CAS C/S SWT(VA)

2.A

3.J

4.J (M)

5.J (A)

6.J (S)

7.J (L)

8.J (N)

9.G

10.X

11.U

12.SWT(WT)

13.STR

14.SPF

15.STL

16.(R)

18.STE(ER)

19.STE(E)

20.STE(ET)

21.SWT(CP)

22.SWT(LT)

23.SWT(VA)

24.SWT(SX)

25.SMT

26.SEM

Import motor fuel for use, distribution or sale

Produce, refine, manufacture or compound motor fuel for use, distribution or sale

Purchase motor fuel for resale	 Blend
in wholesale quantities to retail
dealers inside or outside Utah
(does not require a license if all
Utah tax is paid to a Utah
licensed distributor)

Import aviation fuel for use, distribution or sale

Make aviation fuel retail sales to both federally certificated air carriers and other persons

Produce, refine, manufacture or compound aviation fuel for use, distribution or sale

Purchase aviation fuel for resale  Blend in wholesale quantities to retail

dealers inside or outside Utah (does not require a license if all Utah tax is paid to a Utah licensed distributor)

Import petroleum products for use, distribution or sale

Produce, refine, manufacture or compound petroleum products for use, distribution or sale

a.Motor fuels

b.Diesel/biodiesel fuels

c.Aviation fuels

d.Other petroleum

State importing from:

State importing from:

State importing from:

State importing from:

_____	Supplier name: _____________	Est. gallons per month: ____
_____	Supplier name: _____________	Est. gallons per month: ____
_____	Supplier name: _____________	Est. gallons per month: ____
_____	Supplier name: _____________	Est. gallons per month: ____

Section 9 – Mining Severance

9a. When will you start operations in Utah?

Month Day Year

Section 10 – Oil & Gas Conservation and Severance

10a. When will you start operations in Utah?

Month Day Year

10b.DOGM Number

Issued by the Utah Department of Natural Resources:_____________

Section 11 – Radioactive Waste

11a.When will your Utah facility begin operation?

Month Day Year

USTC Use

Only

OGC

OGS

12b. Business Activities

 Check each box where your answer is "yes." Notify the Tax

Commission if any of the information changes.

1. Will you purchase tobacco products (shisha; moist snuff; RYO, pipe and chewing tobacco; snus; etc.) tax-free for sale in Utah?

•Bond required. Check “Tobacco Products Distributor” on page 1 (1a) and attach bond.

The cash or surety bond value must equal your estimated quarterly tobacco products tax

($500 minimum). The Tax Commission may require you to increase your bond if your actual tax is greater than the estimated amount.

Estimate your tobacco products tax for a quarterly reporting period: $________

2.Will you purchase unstamped cigarettes and affix a Utah stamp prior to sale or distribution?

•Bond required. Check “Cigarette Stamper” on page 1 (1a) and attach bond. The minimum value of the cash or surety bond is $500.

Note: Unpaid cigarette stamp purchases may not exceed 90 percent of your bond value.

3.Will you make retail sales of cigarettes and/or tobacco products (RYO tobacco, shisha, moist snuff, etc.)?

•Signed & notorized affidavit required if:

a)you are not required to post a bond (see questions 1 and 2, above), AND

b)you will sell ONLY stamped cigarettes (no other tobacco products).

The affidavit must state that you will only sell stamped cigarettes.

4.Are you a Participating Manufacturer of cigarettes or RYO tobacco?

5.Are you a Non-participating Manufacturer of cigarettes or RYO tobacco?

6.Will you operate a cigarette rolling machine in Utah?

•Certification required. Attach form TC-550.

USTC Use Only

1.distributor

2.stamper

3.retailer

4.PM mfg

5.NPM mfg

6.RMO

7.PACT

Always file tax returns by the due date and pay taxes in full. You must file a return, even if no taxes are due. Enter zero tax, sign and date your return, and file by the due date.

You must file and pay timely, even if you do not receive a preprinted form. Get forms online at tax.utah.gov/forms, at all Tax Commission locations, or by calling the automated forms line at 801-297-6700.

If you do not file a return or pay taxes due, you will be sent a tax delinquency notice and/or contacted. If you disagree with an action taken by the Tax Commission, you may file an appeal within 30 days of receiving the notice. See Pub 2, Utah Taxpayer Bill of Rights.

For questions about EFT payments, see form TC-85 for sales and use tax, or call 801-297-3817. For employer withholding, see Pub 43, or call 801-297-7626.