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Get UT USTC TC-569A 2020

Utah State Tax Commission Clear form TC-569A Rev. 1/13 Ownership Statement Division of Motor Vehicles PO Box 30412 Salt Lake City UT 84130 Telephone 801-297-7780 or 1-800-368-8824 Get forms online - tax. utah. gov Section 1 - Vehicle Information Year Make License plate number Model Vehicle/Hull Identification Number VIN/HIN State last registered Trailer length Body type Watercraft length ft in Section 2 - Owner Information Primary owner s name last first middle initial or business name Co-owner s name if at different street address check here Street address primary owner City State ZIP code Mailing address if different from Street Address primary owner and list on back Section 3 - Facts and Indemnification Agreement Value of vehicle Purchase price Date of purchase If the fair market value of the vehicle exceeds 1 000 a surety bond may be required not to exceed twice the fair market value of the vehicle. This value may be reassessed by the Division during the application process. Explain why outstanding certificate of title was not obtained or why the attached certificate of title is not valid* Explain in detail how where and when you acquired the vehicle who was involved the condition of the vehicle and any other information regarding the vehicle. Under penalties of perjury I declare that to the best of my knowledge and belief this statement is true correct and complete. I further state that to the best of my knowledge the vehicle is free and clear of any liens encumbrances lawful claims demands of any person and is not involved in any existing or pending litigation* I agree to indemnify the Utah State Tax Commission and all persons acting under direction of the Commission from any and all liability and shall defend all litigation that may arise as a result of the issuance of a certificate of title in my name. Signature of applicant Date X For Office Use Only NCIC Check No Hit Found Partial Hit Found Officer/Agent name Agency name ID/Badge number NLETS Search 10 - State No Record Found Record found in. utah. gov Section 1 - Vehicle Information Year Make License plate number Model Vehicle/Hull Identification Number VIN/HIN State last registered Trailer length Body type Watercraft length ft in Section 2 - Owner Information Primary owner s name last first middle initial or business name Co-owner s name if at different street address check here Street address primary owner City State ZIP code Mailing address if different from Street Address primary owner and list on back Section 3 - Facts and Indemnification Agreement Value of vehicle Purchase price Date of purchase If the fair market value of the vehicle exceeds 1 000 a surety bond may be required not to exceed twice the fair market value of the vehicle. This value may be reassessed by the Division during the application process. Explain why outstanding certificate of title was not obtained or why the attached certificate of title is not valid* Explain in detail how where and when you acquired the vehicle who was involved the condition of the vehicle and any other information regarding the vehicle..

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