Free TC-891 - Utah


File Size: 202.1 kB
Pages: 1
Date: July 11, 2003
File Format: PDF
State: Utah
Category: Tax Forms
Word Count: 206 Words, 1,334 Characters
Page Size: 612 x 399.6 pts
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http://tax.utah.gov/forms/current/tc-891.pdf

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ODOMETER DISCLOSURE STATEMENT

TC-891 Rev. 10/95

Federal and State law require that you state the mileage upon transfer of ownership. Failure to complete, or providing a false statement, may result in fines and/or imprisonment. I, (print name of transferor, or transferor's authorized agent) state that the odometer of the vehicle described below now reads:
ODOMETER READING (NO TENTHS)

Check one box only: I certify that to the best of my knowledge the odometer reading reflects the actual mileage. I certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of mechanical limits. I hereby certify that the odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
MAKE VEHICLE IDENTIFICATION NUMBER Transferor's or Authorized Agent's Signature (SELLER) Printed Name of Company MODEL BODY TYPE YEAR

Must sign by hand after form is printed.
Transfer's Address (Street) City State ZIP code

DATE OF STATEMENT
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Transferee's Signature (BUYER) Must sign by hand after form is printed. If an Organization is Transferee, Print Organization's Name Transferee's Address (street) City

Transferee's Printed Name

State

ZIP code

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