Free Utah MVED Original Complaint Report, TC-451 - Utah

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Motor Vehicle Enforcement Division 210 North 1950 West · Salt Lake City, UT 84134 (801) 297-2600 · www.mved.utah.gov

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TC-451
Rev. 4/06

Original Complaint Report
Type of Complaint
Consignment violation Contract issues Failure to deliver title/registration Failure to payoff trade-in Failure to pay warranty company Financial problem Fraud/forgery Misrepresentation Odometer discrepancy Salvage violation Unlicensed dealership or salesperson Official use only
Case number Assigned to

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Date of report

Other:_________________________________________________________

PLEASE READ:
If you have a case filed with another law enforcement agency or the Division of Consumer Protection, involving this same incident, we need the case number and a contact name of who is working on your case. If you have filed a case in civil court, please indicate that below. · Name of agency · Case # · Contact person
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_ ___________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _____________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ______________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

· Contact phone number · Case filed in civil court?

Yes

No

Court and docket number _______________________

Complainant
Name Address City Home phone Cell phone State ZIP Code Business phone Dealer #

Suspect
Name Address City Home phone Cell phone State ZIP Code Business phone Dealer #

Description of suspect (e.g. height, weight, hair/eye color, race, etc.) ___________________________________________
_ _ _ _ _ ___________________________________ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Vehicle Purchased
Year VIN Financed through Make Model Color Purchase price Date of purchase

Trade-In Vehicle
Year
VIN Amount of payoff Bank or finance company Make Model Color Was title delivered? Yes No

Be sure to complete BOTH sides of this complaint form.

The following is a brief detailed statement of facts concerning this case. This information is true and correct to the best of my knowledge. I hereby request the Motor Vehicle Enforcement Division to investigate this complaint.

Statement of Facts:

Attach additional sheet(s) if additional space is needed. Additional sheets attached?

Yes

No

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I understand this complaint represents a claim filed with the Motor Vehicle Enforcement Division in accordance with Title 41, Chapter 3, Utah Code. I understand if this claim is filed within one year after the cause of this action arose, I have two years from the date on this claim to file an action against the Dealer Bond. I also declare, under penalty of perjury, to the best of my knowledge all statements made are true, correct and complete. Under Utah Code §76-8-506 a person is guilty of a class B misdemeanor if he knowingly gives or causes to be given false information to any peace officer or state employee. ______________________________________ Signature of complainant ______________________________________ Printed name of complaintant
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__________________ Date

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NOTE: You must also submit a photocopy of any and all documentation (i.e. contract, warranty papers, odometer statements, titles, cancelled checks, witness statements, etc.) to support your complaint. The case will be assigned and reviewed by an officer. Once this is done you will be contacted. If you were able to resolve this case on your own, please contact our office.