Utah State Tax Commission
210 N 1950 W, SLC, UT 84134 www.tax.utah.gov
Notice of Change
for a Tax Account
1 — General Information
1a. Social Security Number (SSN)
Federal Employer Identification Number (EIN)
(required for individual sole proprietor)
(required for all entities other than sole proprietor)
1b. Existing Tax Account Number(s)
(required for all accounts)
Sales Tax:
Withholding Tax:
Mineral Prod. Withholding:
1c. Name of Business Entity or Sole Proprietor - PRINT
Daytime phone number
Owner's street address
Cell phone number
City
County
State
ZIP code
2 — Account Changes
Mark all boxes that apply.
2a. Close account (mark all that apply):
Sales tax
Transient room tax
Motor vehicle rental tax
Restaurant tax
Waste tire recycling fee
Mineral prod. W/H tax
Effective date: _____________
Withholding tax
2b. Change address (mark all that apply):
Sales tax
Withholding tax
Mineral prod. W/H tax
Physical address
DBA address
Mailing address
2c. Change phone number (mark all that apply):
Sales tax
Wtihholding tax
Mineral prod. W/H tax
New phone number: ____________________________
2d. Change DBA/Business name:
Mark here and attach Dept. of Commerce Articles of Incorporation
2e. Add/remove officer/owner:
Mark here and attach Dept. of Commerce Change Form
2f. Other:
Mark here and explain:
Continued on next page (back)
S T C
W T H *
W M P *
* If you do not have a 14-character
account number, enter your
six-character account number.
New address
City
County
State
ZIP Code
TC-69C
Rev. 10/08
Read the instructions at the bottom of page 2 before filling out this form.
Use this form to report changes for:
• an existing withholding tax account
• an existing sales tax account
• existing outlets for a sales tax account
• an existing mineral production withholding account
To register a new business, use form TC-69. To report new
outlets for an existing sales tax account, use form TC-6