Utah State Tax Commission TC-2001 210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov Application For Tax Clearance Rev. 1/08 A processing fee of $50.00 is required with this application. In accordance with Utah Code §§16-10a-1403, 16-10a-1520 and 16-6a-1403, a tax clearance is hereby requested to dissolve a domestic corporation or to withdraw a foreign corporation. Name of corporation Corporation's current address State City Utah Incorporation/Qualification Number Federal Identification Number Incorporated under the laws of Check one: ZIP code Parent Name Parent Federal EIN Profit Non-profit List all Utah tax account numbers and closeout dates (Income, Sales, Withholding, Fuels, Beer, Tobacco, etc.) Name of corporate representative Telephone number Signature of corporate representative Date signed Please note: Routine processing takes 8 to 12 weeks from the date of application. Failure to timely file tax returns, pay outstanding liabilities, or respond to Tax Commission communications will lead to delays in the timely issuance of the certificate. If there is no response to the Tax Commission’s request, tax clearance applications will expire 90 days from the date of the requirement letter. The $50 fee is valid for 1 year from the date of the request. The certificate expires 90 days from the date of issue. You must contact the Department of Commerce to conclude the dissolution or withdrawal process. Office Use Only Name of person to receive tax clearance Address City State ZIP code Telephone Number $50 fee received For more information or assistance, you may contact the Tax Commission by calling (801) 297-2200 or toll free 1-800-662-4335. Return ENTIRE form, coupon and payment to the address below. Return the original; make a copy for your records. Tax Clearance Fee 50.00 Corporation name Federal Employer Identification Number This bottom portion must be filled out. Return to: Utah State Tax Commission 210 N 1950 W Salt Lake City, UT 84134