1. Clear form
Utah State Tax Commission
TC-40TS
Tax Shelter Disclosure for Material Advisors Rev. 12/08
Get forms online - tax.utah.gov
EIN or Social Security Number
Material advisor's name Telephone #
City State Zip code
Mailing address
Attach a copy of the statement or return filed with the Internal Revenue Service (IRS) pursuant to section 6111 of the Internal Revenue
Code (IRC), currently IRS Form 8918, Material Advisor Disclosure Statement. Also, include all documentation submitted to the IRS in
connection with the statement or return and mail to the address shown below.
Certification: I certify that this return and any attachments are to the best of my knowledge and belief true, correct and complete.
Date signed
Official title
Signature
Firm's name (or yours if self-employed)
Signature of person preparing this return
Paid
preparer
use only Address City State ZIP code ID number Date signed
Mail form to: Utah State Tax Commission
Attention: Auditing Division
210 N 1950 W
SLC UT 84134-2000