TC-123, Application For Utah Duplicate Title

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Application For Utah Duplicate Title

$6.00 Fee Required

TC-123 Rev. 8/11

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.

Part 1 - Application for Duplicate Utah Title

Section 1 - Owner Information Primary owner's name (last, first, middle initial or business name)

(Missing, altered, or incorrect information may result in rejected application.) 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)

City

State ZIP code

Section 2 - Vehicle Information Vehicle/Hull Identification Number (VIN/HIN)

Year

Make

Model

Section 3 - Owner(s) Signature

I certify that the original certificate of title for this vehicle has been lost, stolen, mutilated, or made illegible, and has not been endorsed and delivered to a transferee, pledged as collateral, or delivered to a lending institution. I here by make application for a duplicate certificate of title and agree to indemnify the Utah StateTax Commission and all persons acting under its direction from any and all liability and shall defend, at my expense, all litigation which may arise as a result of the issuance of the duplicate certificate of title.

Owner's signature

Date

Co-owner's signature

Date

X

X

Section 4 - Lien Holder Information and Lien Release Lien holder's name (last, first, middle initial or business name)

Signature of lien holder (releasing interest) X

Mailing address

Title

City

State ZIP Code

Date

Part 2 - Assignment and Release of Interest

Section 1 - Odometer Disclosure and Reassignment of Title

(Missing, altered, or incorrect information may result in rejected application.)

I certify that the odometer reading: (check one)

Date of sale

Reflects actual mileage for this vehicle

Enter odometer reading (no tenths)

Reflects the mileage in excess of the odometer's mechanical limits Is not the actual mileage. Warning - Odometer Discrepancy

Sale price $

As owner, I hereby transfer all rights, title, and interest to this vehicle to the new owner named below. I certify, to the best of my knowledge, that the title is free and clear of encumbrances, except the lien to the new lien holder, if any. I certify that the odometer and sales information provided is correct, and that any brand information recorded on the previous certificate of title has been disclosed to the new owner and lien holder on form TC-814.

Owner's signature

Date

Co-owner's signature

Date

X

X

Section 2 - New Owner and Lien Holder Information New owner's name (last, first, middle initial or business name)

New lien holder's name (last, first, middle initial or business name)

Street address (new owner)

Mailing address (new lien holder)

City

State ZIP Code

City

State ZIP Code

New owner's signature X

Date

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