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                                                                                              Print Form             Clear form

Utah State Tax Commission                                                                                                                        TC-69
Utah State Business and Tax Registration                                                                                                         Rev. 5/21
                                                                                                                               tax.utah.gov
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 
     TobaccoProducts Distributor*                        TC-69TOB                           Use Tax license. If you do not 
     E-cigaretteProducts / 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 
Alien Registration Number issued by the U.S. Citizenship and 
Immigration Service.

                    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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