Fillable Application To Request A Motor Vehicle Account printable pdf download

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Utah State Tax Commission

TC-895

Division of Motor Vehicles • PO Box 30412 • Salt Lake City, UT 84130 • 801-297-7780 or 1-800-368-8824

Rev. 12/16

Application to Request a Motor Vehicle Account

Get forms at tax.utah.gov/forms

The following information must be submitted to the Division of Motor Vehicles in order to establish a Motor Vehicle Information Telephone

Account and/or 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.

Note: Use form TC-890 to request release of protected motor vehicle information.

Section 1: Applicant Information

Applicant name

Company name

Mailing address

City

State

ZIP code

Street address (if different from Mailing address)

City

State

ZIP code

Federal ID number (required)

Phone (include area code)

Fax (include area code)

Email (required)

Section 2: Type of Account

Check the type of account you are applying for below:



Phone account: Monday-Friday, 8:00 A.M.-5:00 P.M. (excluding holidays); $3.00 per record



Title, Lien and Registration (TLR): Online, 24/7 access; $2.00 per record



Both Phone and TLR

Section 3: Reason(s) for Entitlement to Protected Motor Vehicle Information

Check the box that best describes why you are entitled to protected motor vehicle information under the Federal Driver’s Privacy Protection

Act (DPPA), Title 18, Section 2721. If the motor vehicle records you access are used contrary to DPPA standards, federal and state penal-

ties 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 in the “Other” section 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.)

License number: _ _____ _ _ _ _ _ _ _ _ _ _ _ _ UDOT number: _____________ Location:_______ __ __ __



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 a current

license.)

License number: _ __ ___ __ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________



Other (Provide a detailed explanation of your need.)

_ _ _ __ _ __ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ __ __ ___ _________________________ __ __ __ _

Application To Request A Motor Vehicle Account

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