Form Tc-661 - 2012 Certificate Of Inspection

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Utah State Tax Commission
TC-661
Rev. 12/12
Certificate Of Inspection
Get forms online - tax.utah.gov
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130
· Telephone
801-297-7780 or 1-800-368-8824
Any Alteration or Erasure Will Void This Document.
Units registered in the State of Utah for the first time (except new units sold by licensed and bonded Utah dealers) must be inspected
to verify the vehicle/hull identification number.
Section 1 - Applicant Information
Name (last, first, middle initial, or business name)
Address (street, city, state, zip)
Section 2 - Vehicle/Vessel Information
Vehicle/Hull Identification Number (VIN/HIN) or serial number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
VIN/HIN location
Plate number
Body-right
Trunk
On engine
Visible through windshield
State of issue
Body-left (driver side)
Engine compartment
Frame
Other: _______________________
Year
Make
Model
Body style
Cylinders
Fuel type
Engine size
Length (trailers and watercraft)
Hull material (watercraft)
HP________ CC________
ft________ in________
Propulsion type (watercraft)
Inboard (ex. I/O & Jet)
Jetdrive
Outboard
Outboard outdrive
Airboat
Sailboat
Section 3 - Inspection Certification
Only a DMV employee, designated contractor, Utah peace officer, licensed dealer or a certified safety inspector may sign below verifying
that the officer or agent has physically inspected the identification number (VIN/HIN) as it appears on the unit. Inspection by out-of-state
peace officers and authorized agents of other state motor vehicle offices will be accepted.
This is to certify that I have personally inspected the unit described above and find the description to be correct.
Date
Signature of officer or agent
X
ID, badge, dealer or license no.
Department, dealer or station name
For Office Use Only
NCIC Check
No Hit Found
Hit Found
Partial Hit Found
Agency name
Officer/Agent name
ID/Badge number
Date
NLETS Search
10 - State
50 - State
No Record Found
Record found in: ______________________________________________
Officer/Agent name
Agency name
ID/Badge number
Date

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