1. Clear form
Division of Motor Vehicles
UTAH STATE TAX COMMISSION
Application For Utah Title
210 North 1950West Salt Lake City, Utah 84134
Telephone (801) 297-7780 or 1-800-DMV-UTAH
Get forms online - tax.utah.gov
Salvage Title Dismantling Permit
Change of Ownership Change of Lienholder Corrected Title
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)
Street Address (Primary Owner) City State ZIP Code
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 Relationship to Co-Lessee:
(Individuals use Last, First, Middle Initial, if Business use DBA)
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 ATV-Off Highway Fund Friends For Sight
Contribute $2 to: Organ Donation Support
Enter mileage, no tenths
Brand type, if branded titled
Reflects actual mileage for this vehicle
Reflects the amount of mileage in excess
of the odometer mechanical limits Unit Number
Fleet Number
Is not the actual mileage for this vehicle
Warning - Odometer Discrepancy
Year Make VIN/HIN/Serial Number Fuel Type
Heavy truck (over 12,000 lbs) Registered Wt. Cylinders
Color of vehicle/vessel - Required:
City ZIP Code
Situs address of vehicle/vessel, if different from Street Address above State
Section 4 - Lien Holder Information
Lien Holder Name
Mailing Address City State ZIP Code
Section 5 - Purchase Information
Purchase Price Previous State of Title Previous Title Number
Purchase 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.
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-656 MVA Rev. 8/07