Form Tc-305 - Motor Vehicle Salvage Buyer Application Page 2
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2TC-305, page 2
Both the applicant and the employer must complete this page.
To Be Completed by Employee
If you are not a U.S. citizen, you must apply in person at MVED, 210 N 1950 W, Salt Lake City, Utah. Bring proof that you are
in the United States lawfully under 8 U.S.C. 1641. Also bring your employment authorization card and documentation show-
ing the I-94 (arrival/departure) number and Alien Registration Number issued by the U.S. Citizenship and Immigration Service
A. Under state and federal law we cannot issue a license to any person who does not provide this residency information:
Check one (Providing false information subjects the signer to the penalties of perjury.):
I am a U.S. citizen. SSN: ___ ___ __ ___ ___ __
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94#: __ _ __ _ __ _ _ _ _ __ _ _
Alien #: _ __ _ __ _ __ _ __ _ __ _
Employment authorization card #: _ __ _ __ _ __ _ __ _ __ _
The Alien Registration Number (A#), I-94 (arrival/departure) number and employment authorization card are issued by the U.S. Citizenship
and Immigration Service.
B. I am in compliance with the Motor Vehicle Business Regulation Act, Salvage Buyer Law, and other laws of Utah govern-
ing the conduct of motor vehicle salvage buyers and will cooperate with the Utah State Tax Commission to eliminate
abuse and unfair trade practices.
I am in compliance with all laws and regulations regarding the disposal of hazardous material under Hazardous
Substances, and will provide evidence of compliance to MVED upon request.
I hereby state that I will engage in the business of purchasing salvage motor vehicles for the designated dealer, body
shop or dismantler shown below during the license period for which this application is made.
I certify under penalty of perjury that the statments made on this application are true and correct.
Complete the rest of this form by hand after it has been printed.
Applicant’s signature: ____ ___ ___ ___ __ _ ___ _____ __ _ __ _ __ _ _ __ _ __ _ __ _ __ _ __ _
Printed name of applicant: ________________________________________________________________ Date: ______/_______/________
To Be Completed by Employer
I hereby certify that ____ ___ ___ ___ __ _ ___ _____ __ _ _ __ _ __ _ __ _ __ _ __ _ _ _ _ __ _
Applicant’s name (please print)
is employed as a salvage buyer by the undersigned who has been duly licensed as a motor vehicle dealer, body shop or
dismantler by a U.S. state or jurisdiction.
IMPORTANT:
I/we certify under penalty of perjury that the statements made on this application are true and correct to
the best of my/our knowledge and belief. I/we recommend the applicant to be licensed to purchase salvage motor vehicles.
Providing false information subjects the signer to the penalties of perjury.
_________________ __ ___ ___ ___
_ __ __ _ __ _ __ _ _ __ _ __ _ __ _ __ _ __ _
Business name
Address
_______________ ___ ___ ___ __ __
_ __ __ _ __ _ __ _ _ __ _ __ _ __ _ __ _ __ _
Signature of owner, partner or corporate officer*
Printed name of signer*
___ _ __ _ __ _ _ __ _ __ _ __ _ __ __ _ __ _
Date
* The signer must be on file with MVED as an owner, partner, corporate officer or POA.
This application will be rejected if it is incomplete or
does not include the correct license fee and a photograph of the applicant.
Make check or money order payable to: Utah State Tax Commission
Motor Vehicle Enforcement Division
210 North 1950 West
Salt Lake City, UT 84134
Print Form
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
Clear form
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