Form Tc-203 - New Utah Special Group Plate Application

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Utah State Tax Commission
TC-203
New Utah Special Group Plate Application
Rev. 5/12
Submitted by Individuals to the Plate’s Sponsoring Organization
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824
Get forms online - tax.utah.gov
Section 1 - Sponsoring Organization Information
Name of the special group plate
Name of the sponsoring organization
Relationship to co-owner:
And
Or
Section 2 - Vehicle Owner Information
Primary owner’s name (last, first, middle initial, or business name) Co-owner’s name
Street address (primary owner)
City
State ZIP code
Mailing address, if different from Street Address (primary owner)
City
State ZIP code
Phone number
E-mail address
Section 3 - Vehicle Information (Passenger, Truck, or Trailer Only - Motorcycles are not eligible for Special Group Plates)
Vehicle must have a valid registration in order to issue the special group plate.
Year
Make
Model
Plate number
Vehicle Identification Number
Registration expiration (mm/yyyy)
Section 4 - Owner(s) Signature
I declare that I am the owner of the vehicle described on this application and that all the above information is accurate and true. I
understand that this application is an attempt for the Sponsoring Organization to collect 500 applications, and that this Special Group
plate is not available for purchase at this time. If and when the Sponsoring Organization meets the provisions of Utah Code 41-1a-418
(2)(a), this plate will be available for issue within 6 months. At that time the special group plate listed will be issued to the vehicle and
owner identified above. The plate will be mailed to the address above.
Date
Owner’s signature
Date
Co-owner’s signature
X
X
This application along with the required funds* should be submitted directly to the organization sponsoring this
Special Group Plate. Any question concerning this plate should be directed to the Sponsoring Organization.
* Required Funds
$10.00
Special Plate Fee
5.00
Registration and Decal Replacement
3.00
Postage
_______ Initial Contribution (Determined by Sponsoring Organization)
$_______ Total Amount Due with Application
Total amount due payable to Sponsoring Organization.
* NOTE: Additional registration fees may be due if vehicle does not have a current registration.

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