Utah Insurance Premium Tax Payment Coupon (replaces TC-670)

Insurance Premium Tax Payment Coupon (replaces TC-670)
TC-62PC, Utah Sales Tax Payment Coupon
Utah State Tax Commission

Insurance Premium Tax Payment Coupon

TC-49PC
Rev. 8/11

Payment Coupon

Electronic Payment

Use payment coupon TC-49PC to make quarterly insurance
premium tax payments.

You may make this payment online at tap.utah.gov.
___________________

Instructions
1. Do not submit this form if no payment is due.
2. Quarterly prepayments are due only if the prior year’s tax was
$10,000 or more.
3. Quarterly prepayments may be based on either:
a. 27 percent of the prior year’s tax liability, or
b. estimated insurance premium tax for the calendar quarter.

If you have questions about the Insurance Premium Tax, please
call 801-297-2200, or 1-800-662-4335 if calling from outside the
Salt Lake area.
If you need an accommodation under the Americans with
Disabilities Act, contact the Tax Commission at 801-297-3811 or
TDD 801-297-2020. Please allow three working days for a
response.

4. Return this coupon and payment to the address listed on the
coupon by the due date. Due dates are April 30, July 31 and
Oct. 31 of the taxable year. Final payment is due with the
annual return, which is due March 31.
5. The return and return payment are due on March 31.
6. Penalty and interest charges apply to any underpayment.

Where to File
Send your payment coupon and payment to :
Utah State Tax Commission
Insurance Premium Payment
210 N 1950 W
Salt Lake City, UT 84134-0130


TC-49PC

Separate and return only the bottom portion.

Tax Payment Coupon for Insurance Premium, TC-49PC

Rev. 8/11

Insurance Premium Account ID
Payment Type:
1st qtr. estimate

Taxable Year Ending (mm/dd/yyyy)

00

Amount Paid:

Annual return pmt.

2nd qtr. estimate

Make check or money order payable to the Utah State Tax
Commission. Do not send cash. Do not staple check to
coupon. Do not send check stub.

3rd. qtr. estimate
Name of Filer
Address
City

State

ZIP Code

Mail to: Utah State Tax Commission, 210 N 1950 W, SLC UT 84134-0130

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