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                                                                                              Print Form             Clear form
              	
Use form TC-69 to register with the Utah State Tax Commission for the taxes listed below. Read the instructions on the last page 
carefully before filling it out. 

     You can register your business online! 
      • tap.utah.gov - Taxpayer Access Point. For faster processing, register online. Tax Commission only.
      • osbr.utah.gov - OneStop Business Registration. Register your business with the Tax Commission, 
        Department of Commerce, Department of Workforce Services and select cities, all in one place.
      • corporations.utah.gov - Register, renew or update your business or business name with the Department 
        of Commerce. No Tax Commission services available here.

Section 1 – Type of Registration 

1a.  Check each box that applies                   Attach Schedule                    Click the schedule name to We cannot process applications 
      Employer Withholding License                        TC-69WTH                           download the form.without the required schedules.

      Mineral Production Withholding                      TC-69WTH
       Sales and Use Tax License                          TC-69STC
       Cable Operator or Multi-Channel Video              TC-69STC
        or Audio Service Provider                                                                     USTC Use Only

     Natural Gas or Electricity Purchases for           TC-69STC
        Resale or Transportation
     Fuel Tax License (motor fuel, special fuel,         TC-69FUEL
        aviation fuel, hydrogen, environmental 
        assurance fee, CNG, LNG) 
     International Fuel Tax Agreement                    TC-69FUEL
     Special Fuel User                                   TC-69FUEL
       Cigarette, Tobacco, Nicotine, E-Cigarette License* TC-69TOB                   * In order to register for a cigarette, 
          Cigarette Stamper*                           TC-69TOB                           tobacco, nicotine or e-cigarette 
                                                                                              license, you must have a Sales and 
     Tobacco Products Distributor*                        TC-69TOB                           Use Tax license. If you do not 
     E-cigarette Products / Nicotine Products*            TC-69TOB                           already have one, also mark the 
                                                                                              Sales and Use Tax License 
     Out of State Cigarette/Tobacco PACT Act             TC-69TOB                           checkbox and attach TC-69STC.
        Delivery Shipper*
       Beer Tax (distributor/manufacturer only)           TC-69MSC
      Insurance Premium                                   TC-69MSC
      Self-Insured Employer                               TC-69MSC                
     Mining Severance                                    TC-69MSC
     Oil & Gas Conservation and Severance               TC-69MSC
     Radioactive Waste                                   TC-69MSC
       Payroll Service or Third Party Preparer             N/A 
1b.  Previous or existing accounts: Enter all previous or existing Utah tax 
     account numbers for all owners, officers, members, trustees and partners: ___________________________
 ____________________________________________________________
        If you purchase a business, have the seller provide you with a letter from the Tax Commission stating no sales and use tax is 
      
        due, or withhold enough of the purchase money to pay all taxes. You will be held personally liable for the seller's unpaid sales 
        and use tax, including all sales-related taxes, if neither of these conditions is met (Utah Code §59-12-112).
     Sales, withholding and fuel tax licenses are conditional. If an applicant or a fiduciary (officer, member, owner) has a history of filing or 
     paying late, the applicant must resolve past delinquencies and may be required to post a bond. Fuel tax bonds may be combined into 
     one bond, and the amount will be the sum of the required amounts for each fuel tax type. There is an exception to the bond 
     requirement for aviation fuel only; the exception exists if the monthly average tax liability is less than $500 and retail sales of aviation 
     fuel are made to both federally certificated air carriers and other persons.

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Print Form Clear form TC-69_2

Section 2 – General Information

2a. Organizational Structure Must 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
 Tribal  Non-profit  Limited Liability  Corp. Part.
 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
Only fill out lines 2b and 2c if you have a physical presence in Utah. Fiduc.
   Corp. Part.


2b. Organization Date Enter the date of qualification or incorporation in Utah: __________________
(Contact the Dept. of Commerce at 801-530-4849)

2c. Department of Commerce Entity Number Enter number issued by the Dept. of Commerce.

2d. Tax Year End Date: ___________

2e. Federal Identification Number Every sole proprietor must provide a Social Security Number (SSN). A sole proprietor with
employees must also provide an Employer Identification Number (EIN). All other organization types must provide an EIN.
Social Security Number (SSN) Federal Employer Identification Number (EIN)

2f. Name of Legal Entity - PRINT If you are a sole proprietor, write your name here Daytime phone number Cell phone number

Legal entity’s street address City County State Foreign country (if not U.S.) ZIP Code

Legal entity’s mailing address City County State Foreign country (if not U.S.) ZIP Code

Business website address (URL) Email address (provide a valid email address — we will send your account info here) Contact phone number

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

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

Required: Local Utah government issuing this location’s business license for a business physically located in Utah

2h . Officer/Owner Information
Enter the following information for each officer, general partner, managing member, trustee or enterprise owner. You must provide the
SSN of each individual and the EIN of each entity listed (Tax Commission Rule R861-1A-15). The Tax Commission will only discuss
account information with those listed. Attach additional sheets if you need more space. Notify the Tax Commission if any changes occur.
Name and Title - PRINT SSN and EIN Home Address and City/State/ZIP Phone Number
SSN

EIN

SSN

EIN
2i. Business Description Describe the nature of your business in detail (include the types of products sold)

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Print Form Clear form TC-69_3

Section 3 – Authorized Signatures

By signing this form, I confirm that I understand:
1. the Tax Commission will review all officers/owners listed in Section 2h for previous, unpaid tax debt and I may have to resolve tax
issues or post a bond;
2. I must post a bond if I am applying for a tax account of the same type as a prior tax account that was revoked;
3. I must notify the Tax Commission if I add or close a business location; or change the name, organizational structure, officer status or
address of the business; and
4. any person (including employees, corporate directors, corporate officers, etc.) with the authority to direct accounting processes or who
is required to collect, account for and pay any taxes and fails to do so will be liable for a penalty equal to the total amount of tax not
collected, not accounted for or not paid (Utah Code §59-1-302).
I understand my signature confirms I have reviewed this section with every person named on this form.

Third Party Designee
To authorize a third party to discuss your account(s) with the Tax Commission, enter their information here:
Name of third party designee Phone number PIN/PTIN

Third party mailing address City County State Foreign country (if not U.S.) ZIP Code

To grant a third party more authorization than discussing your account(s), complete and submit form TC-737, Power of Attorney and
Declaration of Representative.

Signature Requirements (for organizational structure checked on line 2a):
• Individual/Sole Proprietor ............................................ Signature must match SSN provided in Section 2 (2e)
(for example, a husband or wife may not sign on behalf of each other).
• All Partnerships........................................................... One general partner must sign.
• Corporation / S Corporation ........................................ An officer of the corporation authorized to sign on behalf of the corporation must
sign.
• Trust............................................................................. The grantor or a trustee must sign.
• Limited Liability Company / Single Member LLC......... A member must sign.
• Government................................................................. A government official must sign.

3a. Sole Proprietors Only
You must provide the following information if you are a sole proprietor applying for the tax license(s) shown in Section 1 of this
application. Under state and federal law we cannot issue a license to any person who does not provide this information.
If you are a sole proprietor who is not a U.S. citizen, you must file this application IN PERSON at a Tax Commission office.
Check one (providing false information subjects the signer to penalties of perjury):

  I am a U.S. citizen and have provided my Social Security Number in Section 2 (2e).
  I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully. I-94 Number*: ____________________________

*TheRegistrationI-94 (arrival/departure)Number are issuednumberby theandU.S.the Alien Alien Registration Number*: ____________________________
Citizenship and Immigration Service.
Employment Authorization Card Number*: ____________________________
Under penalty of perjury, I declare that I am a U.S. citizen OR that I qualify under 8 U.S.C. 1641 and am present in the United States
lawfully, and to the best of my knowledge, the information on this application is true, correct and complete.

Sole Proprietors Sign Here __________________________________________ Title: _________________

Print Name: __________________________________________ Date: _________________

3b. All Applicants
Under penalty of perjury, I declare to the best of my knowledge, the information on this application is true, correct and complete.

ALL APPLICANTS Sign Here __________________________________________ Title: _________________

Print Name: __________________________________________ Date: _________________

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TC-69_i
TC-69 Instructions Next Step – Set Up TAP Account
• For better accuracy and faster processing, register online at When you receive your PIN letter(s) by postal mail, go to
tap.utah.gov. tap.utah.gov to set up a TAP account.
• Type or print clearly. Incomplete or illegible registration forms Note: You must file certain taxes online. But even for taxes without
will be rejected. this requirement, using TAP to file and pay taxes online is easier,
quicker and more accurate than paper.
• Complete every section of this form and all required
schedules.
Reporting and Payment Guidelines
• Mail the completed form to the Tax Commission:
210 N 1950 W Always file tax returns by the due date and pay taxes in full. You
Salt Lake City, UT 84134 must file a return, even if no taxes are due. In this case, enter zero
tax and file by the due date.
• Allow 15 business days to process this form.
After processing, we will send your information to the email You must file and pay timely, even if you do not receive a preprinted
address you provided. We will also send you a PIN by postal form. Get forms online at tax.utah.gov/forms.
mail that you will use to set up your online access in TAP If you do not file a return or pay taxes due, we will contact you
(Taxpayer Access Point). and/or send you a tax delinquency notice. If you disagree with a Tax
• Contact the proper city or county for business licensing Commission action, you may file an appeal within 30 days. See Pub
requirements. 2, Utah Taxpayer Bill of Rights.
If you are a sole proprietor applying for a tax license(s) AND you are For questions about EFT payments, see form TC-86 and Electronic
not a U.S. citizen, you must apply in person at a Tax Commission Funds Transfer - EFT (at tax.utah.gov/billing/payments), or call
office and bring proof that you are in the United States lawfully 801-297-3817.
under 8 U.S.C. 1641. Bring your employment authorization card and
documentation showing the I-94 (arrival/departure) number and More Information
Alien Registration Number issued by the U.S. Citizenship and For more information about Utah taxes and business registration, see
Immigration Service. tax.utah.gov, or call 801-297-2200.

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.

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