Form Ut-510 - Transaction Certificate - Iowa Department Of Revenue

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TRANSACTION CERTIFICATE
New Title #
LIEN HOLDER
UT-510
Plate #
IOWA DEPARTMENT OF REVENUE
This certificate must be completed by the applicant
Transfer Date
UT#
before registration will be processed.
Purchaser/
Seller/
Registering Owner: _____________________________
Previous Owner: _______________________________
Address: ______________________________________
Address: ______________________________________
City: ______________________ State: ___ Zip: ______
City: ______________________ State: ___ Zip: ______
Telephone: ____________________________________
Telephone: ____________________________________
NOTE: A copy of the Bill of Sale signed by the seller and buyer may be required.
Purchase
Description
Vehicle Purchased
Vehicle Traded
Price
$ ______________
Make, Model & Yr.
Less
Trade-In
VIN
Allowance
$ ______________
Amount Subject
Old Title #
to One-time
Registration
Check the number below which exempts this transaction from Iowa’s One-time
Fee
$ ______________
Registration Fee and write the number in the UT# box at the top right of this form.
1. Transfer by gift, or withhout consideration (please explain) ______________________________________________
2. Purchaser/lessee is one of the following nonprofit or government organizations:
___ community health center
___ rehabilitation facility
__ hospital licensed under 135B
___ migrant health center
___ legal aid organization
__ free-standing nonprofit
___ nonprofit private museum
___ nonprofit private art center
hospice facility
___ residential care facility for the mentally ill
___ community mental health center
__ procurement organization
___ private nonprofit educational institution
___ government
__ community action center
___ residential care or intermediate care
___ rehabilitation facility for
licensed under 216A.93
facility for the intellectually disabled
intellectually disabled children
3. Vehicle transferred from a sole proprietorship or partnership to a corporation, LLC or vice versa, with the
ownership remaining exactly the same and for the purpose of continuing the same business.
Date of termination of prior business: __________________ Date of the legal creation of new entity: _______________
4. Purchased by a licensed dealer for resale. Dealer license #: _______________________
5. Purchased for rental. Purchaser’s sales tax permit #: _____________________________
6. Leased vehicle used solely in interstate commerce.
7. Vehicle registered and/or operated in Iowa Code Section 326 (reciprocity) with gross weight of 13 tons or more
and with 25% of the mileage outside of Iowa. Both weight and mileage must be met for the first four years of
operation to be eligible for exemption.
8. Other; ie.
____ Mobile home
____ Vehicle is homemade
___ Inheritance or court order
____ Move-In: Previously titled outside Iowa by nonresident moving into
Iowa; provide previous name/address information in “Seller” column
____ Purchased outside Iowa by Iowa resident; attach copy of
___
Name added or dropped
Bill of Sale showing at least 5% of the purchase price paid to
(circle one); provide all
another state
names involved
____ Purchased in Iowa by nonresident; temporary, in-transit title issued
____ Other (please explain) ______________________________________________________________
I, the undersigned, declare under penalties of perjury that I have examined this affidavit, and to the best of my knowledge
and belief, it is true, correct and complete.
Purchaser’s signature: _________________________________________ Date: ___________________________
55-002 (01/30/13)

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