Free Utah Application to Request a Motor Vehicle Account, TC-895 - Utah

Use form TC-890 to request release of protected motor vehicle information.

Clear Form Utah State Tax Commission Application to Request a Motor Vehicle Account

Do not use this form to request release of protected motor vehicle information. The following information must be submitted to the Division of Motor Vehicles in order to establish a "Motor Vehicle Information Telephone Account" and a "Utah Interactive Network Registration Agreement Account". Only applicants who satisfy the federal requirements for access to motor vehicle records will be granted an account.
Applicant's name Mailing address City Federal ID number (required) State Zip code Company name Street address (if different than mailing address) City State Zip code Fax number (include area code)

Telephone number (include area code)

Check the box that best describes why you are entitled to protected motor vehicle information (Federal Driver's Privacy Protection Act, Title 18 Section 2721). If the motor vehicle records you access are used contrary to the FDPP Act, federal and state penalties will apply. For use by a government agency, including any court or law enforcement agency, in carrying out their functions or a private person or entity acting on behalf of a government agency in carrying out its functions. Provide a copy of the signed State contract if you are a private person or entity. For use by a legitimate business or its agents, employees or contractors in the normal course of business to verify the accuracy of personal information submitted by the individual to the business. Provide a copy of a current business license. Explain in detail what your business need is on "other" below. For use by any federal, state or local court or agency connected with civil, criminal, administrative or arbitral proceedings. For use by any insurer or insurance support organization, or by a self-insured entity, in connection with claims investigation activities, anti-fraud, rating or underwriting. For use to provide notice to owners of towed or impounded vehicles. Provide a copy of a current towing business license.
Business license number: __________________. UDOT number: __________________________. Location: ____________________________________________.

For use by an attorney for approved purposes provided by federal laws. Provide a copy of a current license.
License number: _________________________. Expiration date: ___________________________.

For use by any licensed private investigative agency or licensed security service for approved purposes provided by federal law. Provide a copy of a current license for each individual that will be accessing records and list their names on the reverse side.
License number: _________________________. Expiration date: ___________________________.

For use by a new or used car dealer for purpose provided by federal law. Out-of-state dealers must provide a copy of current license.
License number: _________________________. Expiration date: ___________________________.

Other: (provide a detailed explanation of your need)

TC-895 Rev. 12/06

The Utah State Tax Commission reserves the right to notify the individual about whom protected information is requested. As the condition of the disclosure of protected records, the applicant expressly agrees to the following terms: 1. Responsibility. The Applicant assumes all responsibility for the protected records of the Division that may be disclosed pursuant to this application in accordance with Utah Code Ann. Section 41-1a-116, 63-2-202 and the Federal Driver's Privacy Protection Act, 18 USC Section 2721. 2. Training. The Applicant agrees to designate a representative to perform all training required by the Division and to ensure that the Applicant accesses all protected records in accordance with this application. The Applicant agrees to notify the Division of any change in the designated representative and/or authorized individuals that will utilize this access within 10 days from such change. Changes must be on agency letterhead and signed by the Applicant. You may fax these changes to (801) 297-3578, Attn: Special Services. The Applicant agrees to submit the names of all employees that will be utilizing the DMV Information Telephone Account with this application. The applicant agrees to notify the Division in writing of any changes to the list of employees within 10 days of such change. Changes must be on agency letterhead and signed by the Applicant. You may fax these changes to (801) 297-3578, Attn: Special Services. The Applicant will conduct any and all training of its employees and agents as directed by the Division. It is anticipated that training will be required on an annual basis or more frequently depending upon the needs of the Division. The Applicant shall require all employees, prior to access to the protected records, to execute an acknowledgment that states substantially as follows:

"The employee understands that access to the Division's records may only be made in connection with the legitimate business need of the business as permitted by law. Access of the records for an improper purpose, including personal reasons, is prohibited and subject to penalties imposed by law. If the employee learns of any improper use or disclosure of the records, he or she shall report such use or disclosure immediately to his or her supervisor and the Division."
2. Maintenance of Records and Audit. The Applicant agrees to take such steps necessary to ensure the privacy of the records disclosed under this application. Such steps include instructions and directions that may be provided by the Division, the marking of all records as "confidential not to be copied" and the maintenance of written documentation substantiating the basis for the access of each record. For example, if access is made to verify the ownership of a vehicle based upon information supplied by the owner, the Applicant should have in it's records an application, statement or consent signed by the owner representing his or her interest in the subject vehicle. The Applicant agrees to permit the Division reasonable access to all files or documentation pertaining to a disclosed record. Such access may be on an individual basis, such as an investigation of a complaint, or an audit to determine the Applicant's compliance with the applicable laws and procedures of the Division. 3. Limited Use of Records. The Applicant warrants and represents that the protected records of the Division will only be accessed for the purpose marked on this application and that such records will not be used, disclosed or disseminated for any other purpose, including advertising or solicitation purposes in any form. The Applicant understands that the improper use, disclosure, or dissemination of records accessed under this application may violate applicable law and result in criminal sanctions and civil liability. 4. Indemnification. The Applicant assumes responsibility for the records disclosed and agrees to indemnify and hold harmless the Division from any and all claims, demands, actions or liabilities that may arise against the Division by reason of the violation of the aforementioned statutes. 5. Termination. This application and the Applicant's access to records of the Division may be terminated and denied for any reason and at the sole discretion of the Division.
Print applicant's name Print designated representative's name Applicant's title Applicant's signature X Designated representative's signature X Date signed Date signed

Please allow seven working days for review and processing of application. You will be notified by mail that your application has been approved, denied or if more information is needed. Provide names of those individuals that will be utilizing your motor vehicle telephone account below: