Form TC-69 Schedule MSC "Miscellaneous Tax Types" - Utah

What Is Form TC-69 Schedule MSC?

This is a legal form that was released by the Utah State Tax Commission - a government authority operating within Utah.The document is a supplement to Form TC-69, Utah State Business and Tax Registration. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Utah State Tax Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TC-69 Schedule MSC by clicking the link below or browse more documents and templates provided by the Utah State Tax Commission.

ADVERTISEMENT
ADVERTISEMENT

Download Form TC-69 Schedule MSC "Miscellaneous Tax Types" - Utah

212 times
Rate (4.5 / 5) 13 votes
TC-69MSC
TC-69 Schedule MSC
Rev. 6/19
Miscellaneous Tax Types
EIN/SSN: __ __ _ __ __ __ _
Fill out the section(s) that apply. Attach this schedule to your TC-69 form to register for any of the following:
• Beer Tax (distributor/manufacturer only)
• Insurance Premium
• Self-Insured Employer
• Mining Severance
• Oil and Gas Conservation and Severance
• Radioactive Waste
Clear form
Print Form
Section 1 – Beer
1a. When will you start manufacturing or distributing beer in Utah?
Month
Day
Year
1b. Business Type
 
Check all that apply.
1. 
Beer manufacturer
2.  Beer distributor
1c. Out of state beer distributors only: when did/will you start shipping beer into Utah?
Month
Day
Year
Section 2 – Insurance Premium
2a. Are you an admitted insurer who is required to pay tax on premiums received from direct business in Utah? If
yes, when did you start writing insurance in Utah?
Month
Day
Year
Section 3 – Self-Insurer
3a. Are you a self-insured employer? If yes, when did you begin self-insuring in Utah?
Month
Day
Year
Section 4 – Mining Severance
4a. When will you start operations in Utah?
Month
Day
Year
continued on next page
TC-69MSC
TC-69 Schedule MSC
Rev. 6/19
Miscellaneous Tax Types
EIN/SSN: __ __ _ __ __ __ _
Fill out the section(s) that apply. Attach this schedule to your TC-69 form to register for any of the following:
• Beer Tax (distributor/manufacturer only)
• Insurance Premium
• Self-Insured Employer
• Mining Severance
• Oil and Gas Conservation and Severance
• Radioactive Waste
Clear form
Print Form
Section 1 – Beer
1a. When will you start manufacturing or distributing beer in Utah?
Month
Day
Year
1b. Business Type
 
Check all that apply.
1. 
Beer manufacturer
2.  Beer distributor
1c. Out of state beer distributors only: when did/will you start shipping beer into Utah?
Month
Day
Year
Section 2 – Insurance Premium
2a. Are you an admitted insurer who is required to pay tax on premiums received from direct business in Utah? If
yes, when did you start writing insurance in Utah?
Month
Day
Year
Section 3 – Self-Insurer
3a. Are you a self-insured employer? If yes, when did you begin self-insuring in Utah?
Month
Day
Year
Section 4 – Mining Severance
4a. When will you start operations in Utah?
Month
Day
Year
continued on next page
TC-69MSC_2
Section 5 – Oil & Gas Conservation and Severance
Clear form
Print Form
5a. When will you start operations in Utah?
Month
Day
Year
5b. DOGM Number
_____ _ __ __ __ _
Issued by the Utah Department of Natural Resources:
Section 6 – Radioactive Waste
6a. When will your Utah facility begin operation?
Month
Day
Year
Page of 2