Form Tc-162 - Application For Utah Motor Vehicle Identification Number - 2001
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Utah State Tax Commission
TC-162
Application For Utah Motor Vehicle
Rev. 6/01
Identification Number
Division of Motor Vehicle · 210 North 1950 West · Salt Lake City, Utah 84134 · (801) 297-7780 or 1 800 DMV-UTAH (TDD 297-2021)
If you need accommodation under the Americans with Disabilities Act, contact the Tax Commission at
(801) 297-3811 (TDD (801) 297-3819). Please allow three working days for a response.
Reason for application
Altered
Missing
Reconstructed
Newly constructed
Other
Vehicle Information
VIN on title:
VIN on frame:
Utah assigned VIN
VIN on body:
Year
Model
Body type
Make
Affidavit of Construction
Being first duly sworn depose and state that the vehicle described hereon was built, or caused to be built and further swears that all
material and labor involved in the construction of said vehicle are paid in full. I further state that the accompanying documents
(bill-of-sale, invoice, etc.) are for the "essential parts" used in the construction or reconstruction of this vehicle.
The construction was completed _________________________________.
(date)
Warning: Fraudulent application and falsification of documents is a felony under Utah Law.
Under penalties of perjury, I declare that to the best of my knowledge and belief, this agreement is true, correct, and complete. I further
state that to the best of my knowledge, the vehicle is free and clear of any liens, encumbrances, lawful claims, demands of any person,
and that the vehicle is not in any existing or pending litigation. I agree to indemnify the Utah State Tax Commission, and all persons
acting under direction of the Tax Commission, from any and all liability and shall defend all litigation which may arise as a result of the
issuance of said certificate.
Applicant's name (print)
Applicant's address
Applicant's signature
Date signed
MV examiner's signature
Date
Certificate of VIN Plate Installation
Utah vehicle Identification number _______________________________________ has been properly affixed in accordance with the instructions
to the _____________________________________________________________________________________ of the vehicle described.
MV examiner's signature
Date
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