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Utah State Tax Commission
TC-802N
Rev. 10/12
Notice Of Requirement To Obtain Salvage or Non-repairable Title
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
Salvage title
Non-repairable title
Motor Vehicle Information (Print or type legibly)
Year
Make
VIN
Model
Type
Body style
License number
State
Owner name
Address
City
State
ZIP code
Insurance Company Certification
Name of insurance company
This is to certify that on the __________ day of ________________, 20____, our insurance company named above, satisfied a total
loss claim on the motor vehicle described above and the owner elected to retain possession of the salvage or non-repairable vehicle.
As required by Utah Code 41-1a-1005 and 41-1a-1005.5, this is to certify that the above named owner has been notified of the
requirement to obtain a salvage or non-repairable certificate of title on the vehicle identified above.
Insurance company's signature
Title
Date
X
Owner Acknowledgement
This is to certify that on the __________ day of ________________, 20____, I was notified by the above name insurance company of
my obligation to obtain a salvage or non-repairable title within ten days of settlement of my claim, and that I have received a copy of the
notice as required by Utah Code 41-1a-1005 and 41-1a-1005.5.
Owner's signature
Date
X
Original
to the Tax Commission.
Copy
to the insurance company.
Copy
for your records.