Form Tc-817 - Application For Personalized Plates And Replacement Of Existing Personalized License Plates Page 4
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Utah State Tax Commission
Get forms online - tax.utah.gov
Application For Personalized Plates and
Replacement Of Existing Personalized License Plates
TC-817
Includes personalized, personalized special group, personalized disabled and amateur radio
Rev. 10/09
New Order
(payment and vehicle information is required)
Complete Sections 1, 2 and either 3, 4 or 5
.
Personalized Plate Replacement (payment and vehicle information is required)
Complete Sections 1, 2 and either 3, 4 or 5
.
Section 1: Applicant Information Plates can be issued to and used only on the vehicle registered to the person(s) listed below
Check the type of vehicle
Date of application
plates will be used for
Automobile/truck/Van/Utility
Motorcycle
Trailer
Daytime telephone number (required)
Registered owner's name
Mailing address
State
ZIP code
Is this a
new address
?
Yes
No
City
Signature(s)
If a contribution is
required, enter the
X
$ ____________
contribution amount
Section 2: Vehicle Information
Current vehicle information for which personalized plates will be registered:
Make
Current Utah plate no.
Date registration expires
VIN
Model
Year
When completing Section 3 or 4, you need to briefly explain the meaning of the characters you choose. For example, characters
"LV2READ"
could mean, "Love to read." Applications received without explanations may be rejected or denied.
Note:
All plates will be centered, unless clearly noted. Place characters in spaces as you would like them to appear on the plate.
Automobiles, trucks, trailers may use up to 7 characters and motorcycles
Section 3: Personalized Life Elevated Skier or Arches Plates
may use up to 4 characters (no special characters allowed)
Check the box for
“Life Elevated Arches"
or
Life Elevated Arches
Life Elevated Skier
“Life Elevated Skier”
plate design
1st Choice
2nd Choice
3rd Choice
Explain the meaning of the characters you
Explain the meaning of the characters you
Explain the meaning of the characters you
have chosen:
have chosen:
have chosen:
Use up to 5 characters (Slogan varies based on plate type) Check the
Section 4: Personalized Utah Special Group Plates
special group plate you want (no special characters allowed)
American Legion, Boy Scouts, Boys & Girls Club, Children’s Issues, Clean Fuel, EMT, Farm truck, Firefighters, Gold Star,
Utah special group plate (specify type)
National Guard, Homeless Pets, Honoring Heroes, Pearl Harbor, P.O.W., Public Ed. Support, Purple Heart, Search and
Rescue, Share the Road, Snowmobiler, Soil Conservation, Special Interest, Utah Housing Opp., Vintage, Zion National Park
__________________________
American Legion
Disabled
Air Force
Trout
Elk
Bald Eagle
Collegiate
Wildlife:
Veteran:
Army
Coast Guard
Marine
Navy
L. E. Skier
L. E. Arches
Disabled:
College name
1st Choice
2nd Choice
3rd Choice
Explain the meaning of the characters you
Explain the meaning of the characters you
Explain the meaning of the characters you
have chosen:
have chosen:
have chosen:
(Plate characters are the assigned call numbers issued by the FCC or
Section 5: Amateur or Search and Rescue Radio Plate
county sheriff. Use up to 6 characters)
See plate description on pages 2 or 3 for requirements.
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