Form Tc-301 - Bonded Motor Vehicle Business Application Page 4
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4TC-301, page 4 of 4
Special Plates & Decals
Manufacturer
Transporter
Dealer
Dismantler
__ ____
Dealer plates* ($12.00 each) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _ ___ _ _ _ _ _ _
____ __
Motorcycle plates* ($12.00 each) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _ __ _ _ _ _ _ _ _
____ __
Dismantler, manufacturer or transporter plates* ($10.00 each) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _ __ _ _ _ _ _ _ _
*Handling fee ($2.50 for 1-2 plates, $3.50 for 3 or more plates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _ __ _ _ _ _ _ _ _
Total $ ___ _ _ _ _ _ _ _
Additional instructions: _______ ____ ____ _______ ___ ___ __ ___ ___ ___ ___
Decal number (office use only): ____ _ ____ _________ ___ ___ __ ___ ___ ___ ___
Insurance company: ____ ____ ____ _____ _____ ___ ___ ___
Policy number: __ ___ ___ _ _ _ _ _ _ _
Address: _ ___________ ____ _ ____ _______ ___ ___ __
Telephone number: ___ ___ _ _ _ _ _ _ _
Note: You must submit a current copy of your plate insurance declaration every time you order or renew plates. Insurance must be
issued in the name of the licensed business.
Signatures
– All owners must sign
Owner #1
I am familiar with the motor vehicle dealer licensing laws and other laws of Utah governing the conduct of persons in the motor vehicle
industry and will cooperate with the Utah State Tax Commission to eliminate abuse and unfair trade practices.
I certify under penalty of perjury that the above information is correct and complete. I further certify that my business, as reported on this
application, is in compliance with the Motor Vehicle Business Act of the Utah Code.
_ __________ __ ____________ _____ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature*
Date
_ __________ __ ____________ _____ _ _ _ _ _ _
Signer’s printed name
Owner #2
I am familiar with the motor vehicle dealer licensing laws and other laws of Utah governing the conduct of persons in the motor vehicle
industry and will cooperate with the Utah State Tax Commission to eliminate abuse and unfair trade practices.
I certify under penalty of perjury that the above information is correct and complete. I further certify that my business, as reported on this
application, is in compliance with the Motor Vehicle Business Act of the Utah Code.
_ __________ __ ____________ _____ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature*
Date
_ __________ __ ____________ _____ _ _ _ _ _ _
Signer’s printed name
Owner #3
I am familiar with the motor vehicle dealer licensing laws and other laws of Utah governing the conduct of persons in the motor vehicle
industry and will cooperate with the Utah State Tax Commission to eliminate abuse and unfair trade practices.
I certify under penalty of perjury that the above information is correct and complete. I further certify that my business, as reported on this
application, is in compliance with the Motor Vehicle Business Act of the Utah Code.
_ __________ __ ____________ _____ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature*
Date
_ __________ __ ____________ _____ _ _ _ _ _ _
Signer’s printed name
* The signer(s) must be owner, partner or corporate officer, or have POA. Submit copy of POA if applicable.
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Parent category: Financial