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                                                                                         Utah State Tax Commission 
                                                                                 210 N 1950 W  •  SLC, UT 84134  •  tax.utah.gov
                                                                                                                                        TC-69C
                                                                                 Notice of Change for a                                   Rev. 11/21
                                                                            Business and/or Tax Account
                                                                   NOTE:    You can make account changes online at tap.utah.gov.
                                                              
                                                                            Submit a separate TC-69C for each Utah tax account number.
                                                                            To register a NEW business, use tap.utah.gov (Tax Commission only),
                                                                     osbr.utah.gov (multiple agencies) or form TC-69. 
         This section is required. Provide your CURRENT 
  1 – General Information    information on file with the Tax Commission.
1a. Social Security Number (SSN)                          Federal Employer Identification Number (EIN) 
(required for individual sole proprietor)                 (required for all business types other than sole proprietor) 

1b. Utah tax account number

1c. 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 (before any changes)    City                        County             State             Foreign country (if not U.S.) ZIP Code

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

Business website address (URL)                                                    Email address

1d. Account type to change  (mark only the accounts affected by this change; submit additional copies of this form as needed)
          Beer tax                                  Special fuel supplier      Sales Taxes   Sales and use tax        
          Brine shrimp                    Gross receipts                         E-911 emergency srvcs.               Sexually explicit business
             Corporate/partnership       Insurance premium                      Energy                               Transient room
         Fuel Taxes                        Mining severance                       Locomotive Fuel                      Waste tire
            Aviation fuel               Oil & gas conservation                 Lubricating oil                     Self-insurer’s 
            Compressed natural gas      Oil & gas severance                    Multi-channel video/audio           Tobacco, cigarette, e-cigarette
            Environment assur. fee      Radioactive waste                      Municipal telecom                   Withholding (employer)
            Hydrogen                   Property Taxes   MV rental tax                                               Withholding mineral production
            Liquefied natural gas       Centrally assessed                    Prepaid disp. cell phones           International Fuel Tax Agreement
   Motor fuel                                       Railcar                      Restaurant tax                      Special Fuel User

  2 – Address Change       

Mark all that apply:
         Corporate office / legal entity’s street address                 Tax return mailing address
              Your business offices (if any).                                    The address you want to receive tax returns, if 
         Mailing address                                                       different than your mailing address.
              The address you want to receive all written                   Outlet   (for other changes, complete Section 5)
              communications for this account.                                   A physical location where you are licensed to make 
                                                                                 retail sales. 
              NEW Address: _______________________________________
         
  City, State, ZIP: _______________________________________

  3 – Account Closure        
• To close only a single sales outlet, use Section 5.
• Do not use this form to close a corporation. A corporation must withdraw or dissolve through the Utah Dept. of Commerce.
• You must file all tax returns for periods during which the account(s) was open.

                                                                            Close all accounts                                 Continued on next page
   Closure date: ________________ 

                                                                                                                               TC-69C_2
   4 — Other Account Changes                                                                 Print Form              Clear form

4a.  New phone number(s)
         Day: ____________   Evening: ____________   Mobile: ____________ 
4b. Change or add email address:
     The Tax Commission will send all electronic mail to this address.

         New email address:  _______________________________________

4c. Change DBA/Business name:         DBA                              Legal business name
                                  Mark here and attach Dept. of Commerce Articles of Incorporation (not required for sole proprietors)

         New name: ___________________________________________
4d. Add/remove officer/owner:        Mark here and attach Dept. of Commerce Change Form.  

         Add (name and address):    ___________________________________                                              SSN: ____________

         Add (name and address):    ___________________________________                                              SSN: ____________

         Add (name and address):    ___________________________________                                              SSN: ____________

         Add (name and address):    ___________________________________                                              SSN: ____________

         Remove:_______________________________________________

4e. Other – explain: _____________________________________________________________

_________________________________________________________________________

   5 — Outlet Changes and Closure                                       If changing more than one outlet, attach additional sheets in this format.

     • Use Section 5 to report CHANGES to EXISTING outlets. 
     • To add NEW SALES TAX or TRANSIENT ROOM outlets, use form TC-69B. 
     • To add NEW CIGARETTE, TOBACCO or E-CIGARETTE outlets, use form TC-69.
      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.

   Close cigarette/tobacco license outlet Closure date: ___________                         License number:  ______________

   Close e-cigarette license outlet       Closure date: ___________                         License number:  ______________

     Change phone number: ____________________________

  Other: ___________________________________________________________________

__________________________________________________________________________

   6 — Authorized Signature                                             This form will be rejected without a signature.  

SIGN HERE
      Authorized Applicant or Owner                                                                          Date

                                                                                                                           TC-69C_i
TC-69C Instructions
Use this form to report changes to existing businesses already               You cannot use this form to report a new outlet for a 
registered with the Tax Commission.                                          sales tax account. Use form TC-69B (Additional 
                                                                             Business Locations for a Sales Tax Account).
You can make most tax account changes online. Before filling out 
this form, see:                                                    Section 3 Use Section 3 to close your tax account. If this 
                                                                             account has outlets, all outlets will also be closed.
      tap.utah.gov
                                                                             If you only need to close a single outlet for a sales 
Do not use this form to register a new business. 
                                                                             tax account, complete Section 5.
To register a new business, use from TC-69, or register online 
                                                                   Section 4 Use Section 4 to report all other account changes.
at:
      tap.utah.gov or osbr.utah.gov                                Section 5 Use Section 5 to report changes to single sales 
                                                                             outlets, such as a closure or new phone number.
To register a new business location (outlet) for an existing sales           If changing more than one outlet, attach additional 
tax account, use form TC-69B.                                                sheets in the same format.
Get forms online at:                                               Section 6 Sign and date. We will not process this form without 
                                                                             an authorized signature.
      tax.utah.gov/forms
                                                                   Return this form to:
Section Instructions                                                Master Records
Section 1 Fill out Section 1 completely.                            Utah State Tax Commission
                                                                    210 N 1950 W
          In 1c, provide your business information as it was or 
                                                                    Salt Lake City, UT  84134-3310
          is before the change you are reporting on this form. 
          For example, if you are changing your business            or fax to 801-297-3573.
          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.                                               If you need an accommodation under the Americans with 
                                                                   Disabilities Act, email taxada@utah.gov, or call 801-297-3811 or 
Section 2 Use Section 2 to report address changes. Mark the        TDD 801-297-2020. Please allow three working days for a 
          box matching the type of address you are changing.       response.
          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.