TC-123, Application For Utah Duplicate Title

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

Section 2 - Vehicle Information

Vehicle/Hull Identification Number (VIN/HIN)

Year

City City

Make

State State

ZIP code ZIP code

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 State Tax 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) Mailing address

Signature of lien holder (releasing interest)

X

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.)

Utah Code Title 41 requires the seller of a motor vehicle to inform the buyer about the vehicle's mileage, and to provide written disclosure of

that mileage on the title or other authorized transfer document.

Enter odometer reading (no tenths) I certify that the odometer reading (check one):

Reflects actual mileage for this vehicle Reflects the mileage in excess of odometer's mechanical limits Reading is: Miles Kilometers Is not the actual mileage (Warning: Odometer discrepancy)

(Kilometers will be converted to miles on the title.)

Date of sale

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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