Form Tc-895 - Application To Request A Motor Vehicle Account
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Utah State Tax Commission
TC-895
Rev. 1/13
Application to Request a Motor Vehicle Account
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
Use form TC-890 to request release of protected motor vehicle information.
The following information must be submitted to the Division of Motor Vehicles in order to establish a "
Motor Vehicle
Information Telephone Account
" and a "
Utah Interactive Network Registration Agreement Account
". Only applicants
who satisfy the federal requirements for access to motor vehicle records will be granted an account.
Applicant's name
Company name
Mailing address
Street address (if different than mailing address)
City
City
State
State
Zip code
Zip code
Fax number (include area code)
Federal ID number (
required
)
Telephone number (include area code)
Check the box that best describes why you are entitled to protected motor vehicle information under the Federal Driver's
Privacy Protection Act, Title 18 Section 2721 (DPPA). If the motor vehicle records you access are used contrary to the DPPA,
federal and state penalties will apply.
For use by a government agency, including any court or law enforcement agency, in carrying out their functions or a
private person or entity acting on behalf of a government agency in carrying out its functions. Provide a copy of the
signed State contract if you are a private person or entity.
For use by a legitimate business or its agents, employees or contractors in the normal course of business to verify the
accuracy of personal information submitted by the individual to the business. Provide a copy of a current business
license. Explain in detail what your business need is on "other" below.
For use by any federal, state or local court or agency connected with civil, criminal, administrative or arbitral proceedings.
For use by any insurer or insurance support organization, or by a self-insured entity, in connection with claims
investigation activities, anti-fraud, rating or underwriting.
For use to provide notice to owners of towed or impounded vehicles. Provide a copy of a current towing business license.
Business license number: __________________.
Location: ____________________________________________.
UDOT number: __________________________.
For use by an attorney for approved purposes provided by federal laws. Provide a copy of a current license.
License number: _________________________.
Expiration date: ___________________________.
For use by any licensed private investigative agency or licensed security service for approved purposes provided by
federal law. Provide a copy of a current license for each individual that will be accessing records and list their
names on the reverse side.
License number: _________________________.
Expiration date: ___________________________.
For use by a new or used car dealer for purposes provided by federal law. Out-of-state dealers must provide a copy
of current license.
License number: _________________________.
Expiration date: ___________________________.
Other: (provide a detailed explanation of your need)
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Parent category: Financial