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Application For Utah Duplicate Title

$6.00 Fee Required

Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824

TC-123 Rev. 8/11

Get forms online - tax.utah.gov

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 Section 4 - Lien Holder Information and Lien Release

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

X

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

I certify that the odometer reading: (check one) Reflects actual mileage for this vehicle Reflects the mileage in excess of the odometer's mechanical limits Enter odometer reading (no tenths) Is not the actual mileage. Warning - Odometer Discrepancy Sale price (Missing, altered, or incorrect information may result in rejected application.) Date of sale

$

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. Co-owner's signature Date Date Owner's signature

X Section 2 - New Owner and Lien Holder Information

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

X

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

Date

X

Information

TC-123, Application For Utah Duplicate Title

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