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Utah State Tax Commission

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TC-840 Rev. 9/07

Relinquished Personalized Plates and Reassignment
Division of Motor Vehicle, 210 North 1950 West, Salt Lake City, Utah 84134, (801) 297-7780, 800-DMV-UTAH, TDD 297-2020

Plate Number Relinquished by Previous Owner
I hereby relinquish all rights to personalized plate number:

Print plate number here

Print previous registered owner name

Signed by previous registered owner

Date signed

New Owner Application (Please Print)
New owner name Address Plate type City Telephone number State Zip code

Life Elevated Skier

Life Elevated Arches

Pursuant to UC §41-1a-411(2), the DMV may refuse to issue any combination of letters, numbers or both that may carry connotations offensive to good taste and decency or that would be misleading.

Vehicle information where plate will be reassigned (must have current registration)
Current plate Expiration date Year Make VIN

IMPORTANT: All plates must be manufactured and all fees paid. As the registered owner of the vehicle on which they are to be displayed, I hereby make application for the personalized plate combination designated above. Failure of any vehicle owner to comply with the provisions of Utah Code §41-1a-413 concerning surrender of personalized license plates upon transfer, sale or disposal of a vehicle; or failure of any owner to register or renew registration of a vehicle using the personalized license plates issued for that purpose, shall constitute release by that owner of any priority for those personalized license plates; and the Motor Vehicle Division shall make that combination of letters and/or numbers available to the public. Checks should be made payable to the Utah State Tax Commission. Signed (new registered owner only) Date signed