Form Tc-817 - Application For Personalized Plates And Replacement Of Existing Personalized Plates
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Utah State Tax Commission
TC-817
Application for Personalized Plates and
Rev. 9/13
Replacement of Existing Personalized Plates
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
New Order: If you are registering your vehicle now, you must pay registration fees, the plate application fee and complete this
application. If your vehicle is currently registered, you must pay the plate application fee and complete this application.
Replacement: If you are replacing your existing personalized plates, your vehicle must have a current registration. You must pay a
replacement fee and complete this application.
Please attach a check or money order made payable to the Utah State Tax Commission (USTC) to the completed application form and
mail to the Utah State Tax Commission, Division of Motor Vehicles, Miscellaneous Services Unit, PO Box 30412, Salt Lake City, UT 84130.
The required fee shown on this form includes the application fee and any required contribution (for special group plates only).
Replacement ($13)
New Order
Section 1: Vehicle Information
Current Utah plate no.
Date registration expires
VIN
Make
Model
Year
Section 2: Applicant Information
Check the type of vehicle
Date of application
plates will be placed on
Trailer
Automobile/truck/Van/Utility
Motorcycle
Registered owner's name
Daytime telephone number (required)
Mailing address
State
ZIP code
Is this a new address?
City
Yes
No
Section 3: Plate and Character Selection
Check the desired plate (next to the desired plate is the required fee)
Standard (use up to 7 characters)
Motorcycle Standard (use up to 4 characters)
Life Elevated Arches ($58)
Life Elevated Skier ($58)
Life Elevated Arches ($58)
Life Elevated Skier ($58)
Disabled Person (use up to 5 characters)
Radio (use up to 6 characters)
Life Elevated Arches ($63)
Life Elevated Skier ($63)
($13)
($13)
Amateur Radio
Search and Rescue Radio
Utah Special Group Plate (use up to 5 characters) - select from the different plate types on the following pages and enter on the line provided
__________________________________
Special plate type/name
Personalized plates are issued on a first-come, first-served basis. For this reason, you are encouraged to provide three unique choices, in
order of preference. If a choice is not available or not allowed under Utah Code Section 41-1a-411, your next choice may be considered.
Approved personalized plates will be manufactured exactly as shown on this form.
No pecial characters (period, apostrophe, dash, etc.)
s
may be used. Place characters in spaces exactly as you would like them to appear on the plate. Refer to the maximum characters allowed
above for each plate type.
1st Choice
2nd Choice
3rd Choice
Explain the meaning of the characters you
Explain the meaning of the characters you
Explain the meaning of the characters you
have chosen:
have chosen:
have chosen:
Check the desired character justification for the plate
LEFT
CENTER
RIGHT
(if no selection is made, the plate will default to center)
I understand that my application for personalized plates is subject to availability and to the guidelines found in Utah Code Section 41-1a-411.
This application will not be approved if it is not in accordance with these guidelines. I also understand that the division’s acceptance of this
application and payment of fees does not mean that my application will be approved.
Signature
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