Form Tc-123 - Application For Utah Duplicate Title

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Application For Utah Duplicate Title
TC-123
Rev. 8/11
$6.00 Fee Required
Get forms online - tax.utah.gov
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130
· Telephone
801-297-7780 or 1-800-368-8824
Part 1 - Application for Duplicate Utah Title
(Missing, altered, or incorrect information may result in rejected application.)
Section 1 - Owner Information
Primary owner’s name (last, first, middle initial or business name)
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)
State
City
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.)
Date of sale
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
Sale price
Enter odometer reading (no tenths)
Is not the actual mileage. Warning - Odometer Discrepancy
$
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
Owner’s signature
Date
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)
Mailing address (new lien holder)
Street address (new owner)
City
State
ZIP Code
State
City
ZIP Code
New owner’s signature
Date
X

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