Form Tc-656 - Vehicle Application For Utah Title - Utah State Tax Commission

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Utah State Tax Commission

TC-656R

Rental Agency Application For Utah Title

Rev. 12/12

Get forms online - tax.utah.gov

Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130

· Telephone

801-297-7780 or 1-800-368-8824

Section 1 - New Owner Name Information

Relationship to co-owner:

And

Primary owner’s FEIN

Co-owner’s FEIN

Primary owner’s name (last, first, middle initial, or business name)

Co-owner’s name (if at different street address, check here

and list on back)

Street address (primary owner)

City

State

ZIP code

Mailing address, if different from Street Address (primary owner)

State

City

ZIP code

Section 2 - New Lessee Information

And

Relationship to co-lessee:

Lessee’s driver license

no.

FEIN, if business

Lessee’s date of birth

Co-lessee’s driver license no. or FEIN, if business

Co-

lessee date of birth

’s

Lessee’s name (last, first, middle initial, or business name)

Co-lessee’s name (if at different street address, check here

and list on back)

Street address (primary lessee)

State

City

ZIP code

Mailing address, if different from street address (primary lessee)

City

State

ZIP code

Section 3 - Vehicle Information (Missing or incorrect information may result in a rejected application)

Year

Make

Model

Farm use? (Y/N)

Passenger, light truck, van, or utility

Street motorcycle

Cylinders Fuel type

Vehicle Identification Number (VIN)

Small motor vehicles (CC______ HP______)

Motor home l

( ength: ft______ in

______ (Class______)

)

Fleet number

Unit number

Color

MSRP

Off-highway vehicle (check one:

ATV

Motorcycle)

Street-legal ATV

If branded title, brand type

Body type (trailers)

Low-speed vehicle

Snowmobile

I certify that the odometer reading: (check one)

Odometer Disclosure

Manufactured housing

Reflects actual mileage for this vehicle

Heavy truck (registered weight _________________)

Reflects the mileage in excess of the odometer’s mechanical limits

If this is a commercial vehicle, with a registered weight

Enter odometer reading (no tenths)

Is not the actual mileage. Warning - Odometer Discrepancy

of 10,001 lbs and greater, you must provide your

USDOT number: __________________________

Utility trailer (length: ft______ in ______)

Tent trailer (length: ft______ in ______)

Travel trailer (length: ft______ in ______)

Other trailer: ______________________ (length: ft______ in ______)

Certificate of Inspection: Only a MV Examiner, designated contractor, Utah peace officer, licensed dealer, or a certified safety inspector (mechanic) may sign below.

This is to certify that I have personally inspected the above-described unit and find the vehicle information to be correct.

Section 4 - Registration Information

Contribute $2 to:

ATV-Off Highway Fund

Friends For Sight

Organ Donation Support

License Plate Type - Life Elevated Arches plates will be issued unless otherwise indicated. For a new personalized plate, complete TC-817. Additional fees will apply.

Title only

Life Elevated Arches

Life Elevated Skier

Transfer: _________________

Other: __________________________

Situs/physical address of vehicle, if different from street address above

State

ZIP code

City

Section 5 - Lien Holder Information

Lien holder’s name

FEIN or driver license no., if individual

Branch number

Mailing address

ZIP code

City

State

Section 6 - Purchase and Dealer Information

I certify that the vehicle is accurately described on this application and has been delivered to the purchaser named above and that this dealership is in compliance with the

licensing requirements set forth in Title 41 Chapter 3 Part 2 of Utah Code. I also certify that this transaction was completed in compliance with the sales tax reporting

requirements set forth in Section 59-12-107 of Utah Code.

Purchase date

Dealer number

New

Used

Permit issue date

Permit number

Dealer/Authorized representative’s signature

Date

Section 7 - Owner(s) Signature

I declare that I am the owner of the vehicle described on this application and that all the above information is accurate and true. I certify that I will maintain in effect owner’s or

operator’s security (insurance) for this vehicle as required by law in order to operate this vehicle on a highway, quasi-public road, or parking area within this state.

Owner’s signature

Date

Co-owner’s signature

Date