Form Tc-890 - Release Of Protected Motor Vehicle Information (2013)

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Utah State Tax Commission

Clear form

TC-890

Release of Protected Motor Vehicle Information

Rev. 12/13

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

Requestor’s name

Requestor's driver license no. or FEIN, if business

DL state

Current plate (Office Use Only)

Company

DMV Information Account Number

Telephone:

Fax:

Requestor’s address (

this release is not complete without street, city, and ZIP

)

Requested vehicle record plate number, VIN ,or

See attached list

owner's name

Request type (check one)

If out-of-state record search is requested, a VIN inspection is required (TC-661)

Fax ($4 each record)

Mail ($3 each record)

Mail Microfilm ($6.50 each record)

Out-of-state search ($3 each record)

Justification Statement (this document must be signed below)

Check one of the following boxes that describes why you are entitled to protected motor vehicle information as permitted by Utah Code Section

41-1a-116, 63G-2-201 and the Federal Driver’s Privacy Protection Act (DPPA), U. S. C. Title 18 Chapter 123 Section 2721.

If you are faxing or

mailing your request and do not have a DMV Information Account, you must include a copy of your license and/or identification.

This

information may only be used in one of the ways listed below and

cannot be used for debt collection, asset recovery, or skip tracing purposes

For use by any licensed private investigative agency, licensed security service, or attorney for purposes provided

by law - must provide a copy of the written contract if under contract to provide any of the services listed below.

License number: ____________________

Expiration date: ____________________

Court case or investigative file number _____________________.

If you checked this box, you must explain how the request is supported through the DPPA by selecting an additional option

below or by providing additional documentation such as a court order, summons, complaint, etc.

For use by any requestor for service of process or in connection with an order of a court - must submit a copy

of the summons or court order.

For use by any requestor who is the owner of record, or in the case of an incorporated business, an officer of the corporation.

Identifying number from picture ID: _____________________. ID issued by ___________________________.

For use by any requestor with a written consent or Power of Attorney from the owner of record - must submit

a copy of the written consent or Power of Attorney.

For use by a government agency, including any court or law enforcement agency, in carrying out their functions.

Identifying number from government-issued picture ID _____________________. ID issued by ___________________________.

For use by a legitimate business, in the normal course of business, to verify the accuracy of personal and vehicle information

submitted by the owner of record.

Check

I am a dealer (Dealer no. or FEIN: _________________)

I am a financial institution (FEIN: __________________)

one:

I am a motor carrier and am listed on the motor vehicle record (DOT no. or FEIN: __________________)

For use by any insurer or insurance support organization, or by a self-insured for entity claims investigation activities.

Case file name and number __________________________. Insurance organization name _______________________________.

For use to provide notice to the owner of a vehicle under one of the following circumstances:

Vehicle towed or impounded - must provide a copy of the tow bill.

Tower business license number: __________________. State: ____________.

Vehicle potentially subject to a Repairman’s Lien - must provide a copy of the signed work order.

Repairman’s business license number: __________________.

State: ____________.

Vehicle potentially subject to a Storage Lien - must provide a copy of the signed rental/lease agreement.

Mobile home abandoned or in default of rental/lease agreement - must provide a copy of the signed rental/lease agreement

and a statement explaining the park owner’s efforts to locate the owner of record.

Other (please explain)

Requestor’s Signature

* The Tax Commission reserves the right to notify the individual about whom protected information is requested.

As the requestor of this information and the signer of this form, I assume all responsibility for the protected motor vehicle record(s) I am requesting as outlined in

Utah Code Sections 41-1a 116 and 63 -2-202, and the Federal Driver's Privacy Protection Act, U. S. C. Title 18

Chapter 123

Section 2721. I affirm that I am

entitled to this information pursuant to the reason(s) marked above; and acknowledge that the information requested can only be used for the purpose stated on

this application; and this information may not be disseminated or disclosed for any other purpose, including advertising or solicitation purposes. Dissemination or

disclosure may violate Utah Code 6

-2,

53-9-116

and U. S. C. Title 18 Chapter 123. As a condition of the disclosure of the records requested in this

application, I assume responsibility for the records disclosed and agree to indemnify and hold harmless the Division of Motor Vehicles from any and all claims,

demands, actions or liabilities that may accrue against the Division by reason of the violation of the aforementioned statutes.

Requestor’s signature

Date signed