Form Tc-142 - Application For Special Plates And Decals

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Utah State Tax Commission
TC-142
Application for Special Plates and Decals
Rev. 1/13
Return application and fees to :
Motor Vehicle Enforcement Division
210 North 1950 West
Salt Lake City, UT 84134
Telephone: 801-297-2600
Make check or money order payable to Utah State Tax Commission
Please use a separate form for each license type.
Company name: _ __ __ _ __ ___ __ ___ _____________ License number: ____________
Manufacturer
Transporter
Dealer
Dismantler
As owner, partner or corporate officer of the above company, I am applying to the Utah State Tax Commission for the following items:
_ __ __ __ Dealer plates* ($12.00 each – includes decal)...................................................................... $ ______ __ __ __
_ __ _ __ _ Motorcycle plates* ($12.00 each – includes decal) ............................................................... $ ______ __ __ __
_ __ _ __ _ Dismantler, manufacturer or transporter plates* ($10.00 each) ............................................ $ ______ __ __ __
_ __ _ __ _ Renewal decals for dealer plates ($10.50 each) ................................................................... $ ______ __ __ __
_ __ _ __ _ Renewal decals for dismantler, manufacturer or transporter plates ($8.50 each) ................. $ ______ __ __ __
*Handling fee required with each plates order ($2.50 for 1-2 plates, $3.50 for 3 or more plates) .................... $ ______ __ __ __
Total $ ______ __ __ __
Additional instructions: __ _ __ __ ___ ___ __ ___________________
Decal number (office use only): ___ ___ __ ___ ____________________
Renewal decals are for plate numbers: __ ___ ___ ___________________
_ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ ____________________
_ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ ____________________
I, the undersigned, being duly sworn, depose, and say that I have applied for a license to engage in the business shown above; and I
hereby make application for special license plates. The license plates will not be used on any vehicle other than the vehicles authorized
under the provisions of the law.
I further certify, under penalty of law, that all vehicles operated, displaying such special plates, will be insured as prescribed
by law.
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 the name of the licensed business.
_______________________ __ __ _ __
Firm name
_______________________ __ __ _ __
Signature (must be signed by owner, partner or corporate officer or
signer designated by POA on file with MVED)
_______________________ __ __ _ __
Printed name of signer
Print Form
_______________________ __ __ _ __
Date
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