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Dealer Application for Utah Title and Registration
Section 1 - New Owner Name and Address Information
Owner Type - Check One Primary Owner's Name Co-Owner's Name Individual Lessor Trust Business
Get forms online - tax.utah.gov
(Individuals use Last, First, Middle Initial, if Business use DBA)
Relationship to Co-Owner: And Or
and list on back)
(Last, First, Middle Initial) (if Street address is different from above, check here
Street Address (Primary Owner) Mailing Address (Primary Owner), if different from Street Address
City City
State ZIP Code State ZIP Code
Section 2 - Lessee Name and Address Information
Lessee Type - Check One Lessee's Name Street Address Mailing Address, if different from Street Address Co-Lessee's Name Individual Trust Business Relationship to Co-Lessee: And Or City City
and list on back)
(Individuals use Last, First, Middle Initial, if Business use DBA)
State State
ZIP Code ZIP Code
(Last, First, Middle Initial) (if Street address is different from above, check here
Section 3 - Vehicle and Registration Information Contribute $2 to: Missing or incorrect information may result in rejected application.
Passenger Street Motorcycle Light truck, Van, or Utility Trailer (Length: ___________ feet)
ATV-Off Highway Fund
Friends For Sight Outboard Motor
Organ Donation Support Farm use
MSRP: $ _______________
Heavy truck (over 12,000 lbs) Registered Wt. _________________ Off-Highway Manufactured Housing Snowmobile
ATV/Motorcycle
Watercraft (Length: ft_____ in_____) Personal watercraft (Length: ft_____ in_____) Fleet Number Cylinders Unit Number
Small motor vehicle (CC ________ Horsepower ________) Color of vehicle/vessel (required) _____________________ Year Make
Enter mileage, no tenths
VIN/HIN/Serial Number
Fuel Type If Branded Title, Brand Type
License Plate Type - Life Elevated Arches plates will be issued unless otherwise indicated. For new Personalized Plate, complete TC-817, all fees are due. Title only Life Elevated Arches Life Elevated Skier Other: Expiration Date: City State Renewal required ZIP Code
If transferring existing license plate, plate to be transferred: Situs address of vehicle/vessel, if different from Street Address above
Section 4 - Lien Holder Information
Lien Holder Name
Mailing Address
City
State
ZIP Code
Section 5 - Purchase and Dealer Information
Purchase Date Permit Issue Date Permit Number Dealer Number New Dealer/Authorized Representative Signature Date Used
Section 6 - Owner(s) Signature
Federal and Utah laws allow you to decide if you want your motor vehicle information Public: may be disclosed to any business or individual, otherwise the record will be Protected: only disclosed to government agencies, law enforcement, or private entities having a legitimate business need.
Protected record status applies to all owner's of record
Yes - Make my motor vehicle record information Public
I declare that I am the owner of the vehicle/vessel described on this application and that all the above information is accurate and true. I/we certify that I will maintain in effect owner's or operator's security (insurance) for this vehicle/vessel as required by law in order to operate this vehicle/vessel on a highway, quasi-public road, parking area, or waterway within this state. Owner's Signature Date Owner's Signature Date TC-656D MVA Rev. 1/08