TC-569D, Statement of Facts - Utah State Tax Commission
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Utah State Tax Commission Division of Motor Vehicles ? PO Box 30412 ? Salt Lake City, UT 84130 ? 801-297-7780 or 1-800-368-8824
Statement of Facts
TC-569D
Rev. 11/20
Section 1 - Vehicle Information
Year
Make
Model
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Vehicle/Hull Identification Number (VIN/HIN)
Body type
License plate number
State last registered
Section 2 - Statement of Facts
Name of individual completing statement
Trailer length ft _____ in____
Watercraft length ft ____ in ____
Email address
Company name (if applicable)
Email address
Statement:
Under penalties of perjury, I declare that to the best of my knowledge and belief, this statement is true, correct, and complete.
Signature
X
Date
................
................
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