tax.utah.gov forms current tc tc-656d-mva

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  • 1. Clear form Dealer Application for Utah Title and Registration Get forms online - tax.utah.gov Section 1 - New Owner Name and Address Information Owner Type - Check One Individual Lessor Trust Business Primary Owner’s Name (Individuals use Last, First, Middle Initial, if Business use DBA) Relationship to Co-Owner: And Or Co-Owner’s Name (Last, First, Middle Initial) (if Street address is different from above, check here and list on back) City State ZIP Code Street Address (Primary Owner) Mailing Address (Primary Owner), if different from Street Address City State ZIP Code Section 2 - Lessee Name and Address Information Lessee Type - Check One Individual Trust Business Lessee’s Name (Individuals use Last, First, Middle Initial, if Business use DBA) Relationship to Co-Lessee: And Or Street Address City State ZIP Code Mailing Address, if different from Street Address City State ZIP Code Co-Lessee’s Name (Last, First, Middle Initial) (if Street address is different from above, check here and list on back) Section 3 - Vehicle and Registration Information Contribute $2 to: ATV-Off Highway Fund Friends For Sight Organ Donation Support Missing or incorrect information may result in rejected application. MSRP: $ _______________ Farm use Outboard Motor Trailer (Length: ___________ feet) Passenger Street Motorcycle Watercraft (Length: ft_____ in_____) Heavy truck (over 12,000 lbs) Registered Wt. _________________ Off-Highway Light truck, Van, or Utility Manufactured Housing Personal watercraft (Length: ft_____ in_____) Snowmobile ATV/Motorcycle Small motor vehicle (CC ________ Horsepower ________) Unit Number Enter mileage, no tenths Fleet Number Color of vehicle/vessel (required) _____________________ Fuel Type If Branded Title, Brand Type Cylinders Make VIN/HIN/Serial Number Year 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: Renewal required Expiration Date: If transferring existing license plate, plate to be transferred: Situs address of vehicle/vessel, if different from Street Address above City State ZIP Code Section 4 - Lien Holder Information Lien Holder Name City State ZIP Code Mailing Address Section 5 - Purchase and Dealer Information Purchase Date Dealer Number New Used Permit Number Permit Issue Date Dealer/Authorized Representative Signature Date 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