Relinquished Personalized Plates And Reassignment
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Utah State Tax Commission
TC-840
Relinquished Personalized Plates and Reassignment
Rev. 11/12
Ge t fo rm s o nl in e - ta x.u tah .g ov
Division of Motor Vehicle · PO Box 30412, Salt Lake City, Utah 84130 · Telephone 801-297-7780 or 1-800-368-8824
Plate Number Relinquished by Previous Owner
I hereby relinquish all rights to personalized plate number:
Print plate number here
Date
Previous registered owner’s name (print)
Previous registered owner’s signature
New Owner Application (Please Print)
New owner name
Telephone number
City
State
Zip code
Address
Plate type
Other: _____________________________
Life Elevated Skier
Life Elevated Arches
Pursuant to UC §41-1a-411(2), the DMV may refuse to issue any combination of letters, numbers or both that may
carry connotations offensive to good taste and decency or that would be misleading.
Vehicle information where plate will be reassigned (must have current registration)
Current plate
Expiration date
Year
Make
VIN
IMPORTANT: All plates must be manufactured and all fees paid. Personalized plates are issued on a first-come, first-served basis.
As the registered owner of the vehicle on which they are to be displayed, I hereby make application for the personalized
plate combination designated above.
Failure of any vehicle owner to comply with the provisions of Utah Code §41-1a-413 concerning surrender of personalized
license plates upon transfer, sale or disposal of a vehicle; or failure of any owner to register or renew registration of a vehicle
using the personalized license plates issued for that purpose, shall constitute release by that owner of any priority for those
personalized license plates; and the Motor Vehicle Division shall make that combination of letters and/or numbers available
to the public.
Checks should be made payable to the Utah State Tax Commission.
New registered owner’s signature
Date
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