Application For Utah Duplicate Title, TC 123

Division of Motor Vehicles
UTAH STATE TAX COMMISSION
210 North 1950 West Salt Lake City, Utah 84134
Telephone (801) 297-7780 or 1-800-DMV-UTAH
Clear form
Application For Utah Duplicate Title
$6.00 Fee Required
Owner Information
Address Information
Primary Owner’s Name
Street Address
Last, First, Middle Initial
Secondary Owner’s Name
City
State
ZIP Code
Last, First, Middle Initial
Business Name
FEIN
P.O. Box
Fleet Number
Unit Number
City
State
ZIP Code
VIN/HIN
Year
Make
Model
I/We certify that the original certificate of title for this vehicle has not been endorsed and delivered to a transferee or delivered to a lending institution
and/or pledged as collateral. I/We hereby make application for a duplicate certificate of title in lieu of the certificate that was lost, stolen, mutilated, or
illegible, 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/our expense, all litigation which may arise as a result of the issuance of the duplicate certificate of title.
Owner/Applicant’s Signature
Date
Owner/Applicant’s Signature
Date
Lien Holder Information
Lien Release Section
Lienholder of Record Name
Signature of lien holder (of record) releasing interest:
Address
Title
City
State
ZIP Code
Date
Assignment and Release of Interest Section
Odometer Disclosure Required
Reflects the actual mileage for this vehicle
Reflects the amount of mileage in excess of the odometer mechanical limits
Is not the actual mileage for this vehicle Warning - Odometer discrepancy
Enter mileage, no tenths
Sales Purchase Price - Required
Sale Price $
Date of Sale
Print name of seller
Current address of seller (street, city, state, and ZIP Code)
As owner(s), I/We hereby transfer all rights, title, and interest to this vehicle to the new owner named below. I/We certify to the best of my/our knowledge,
that the title is free and clear of encumbrances, except the lien to the new lien holder, if any. I/We certify that the odometer and sales information
provided is correct. Federal and state law require: 1) the owner provide the mileage upon transfer of ownership of a vehicle; and, 2) the owner must
disclose any brand information recorded on the last Certificate of Title.
Owner/Applicant’s (and joint owner/applicant’s) signature for transferring ownership
Date
New Owner’s Section
New Lien Holders Section
Name
Name
Address
Address
City
State
ZIP Code
City
State
ZIP Code
Signature of new owner(s)
Date
Signature of new owner
Date
TC-123 Rev. 10/04