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Fillable Printable Tc-760 - Utah State Tax Commission

Fillable Printable Tc-760 - Utah State Tax Commission

Tc-760 - Utah State Tax Commission

Tc-760 - Utah State Tax Commission

Representative
First name Middle name Last name Alias/maiden name
Home address (physical address, not P.O. box) City State ZIP Code
Home telephone number Work telephone number Citizenship Date of birth Social Security Number
Gender Height Weight Race Eye color Hair color
Male
Female
ft.in.
Place of birth Driver’s license number State of issue
If you are not a U.S. citizen, you must apply in person at MVED, 210 N 1950 W, Salt Lake City, Utah. Bring proof that you are in the United
States lawfully under 8 U.S.C. 1641. Also 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
Under state and federal law we cannot issue a license to any person who does not provide the following residency information:
Check one (Providing false information subjects the signer to the penalties of perjury.):
I am a U.S. citizen. SSN:
________________
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.I-94#:
________________
Alien #:
________________
Employment authorization card #:
________________
The Alien Registration Number (A#), I-94 (arrival/departure) number and employment authorization card are issued by the U.S. Citizenship
and Immigration Service.
I hereby apply for a new/renewal Representative License for the year July 1,
_____
through June 30,
______
.
I certify under penalty of perjury that the statements made on this application are true and correct.
__________________________________ ___________________
Signature of applicant Date
Employer
Business name License number
Business owner’s name (PRINT) Position
I/we certify under penalty of perjury that statements made on this application are true and correct to the best of my/our knowledge and
belief. I/we recommend the applicant to be licensed as a representative of the State of Utah.
__________________________________ ___________________
Signature of owner* Date
*The signer must be an owner, partner or corporate officer, or have power of attorney. Submit a copy of POA, if applicable.
Make check or money order payable to:Utah State Tax Commission
Motor Vehicle Enforcement Division
210 N 1950 W
Salt Lake City, UT 84134
FEE: $26
Utah State Tax Commission
Application for Representative License / New Application
TC-760
Rev. 2/14
Representative number
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