Application For Utah Motor Vehicle Identification Number

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Utah State Tax Commission
Application For Utah Motor Vehicle Identification Number
Rev. 1/13
Get forms online -
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824
Section 1 - Reason for application
VIN altered, missing, or defaced
Reconstructed vehicle
Newly constructed vehicle (Date completed: ___________________________)
Section 2 - Vehicle Information
Body type
Body length (if boat or trailer)
ft________ in________
If essential or major component parts from existing motor vehicles were used in the construction of this vehicle, list all VINs for these parts.
Any Alteration or Erasure Will Void This Document
VIN on title (if reconstructed)
Additional VIN (indicate location)
VIN on body
Check if no VIN found on any major part
VIN on frame
Utah assigned VIN (for office use only)
Section 3 - Affidavit of Construction
Under penalty of perjury, I declare that to the best of my knowledge the information contained hereon is true, correct, and complete.
I further state that to the best of my knowledge, the vehicle is free and clear of any liens, encumbrances, lawful claims, demands of
any person, and that the vehicle is not in any existing or pending litigation. I agree to indemnify the Utah State Tax Commission and
all persons acting under the direction of the Tax Commission from any and all liability and shall defend all litigation which may arise
as a result of the issuance of a Utah Motor Vehicle Identification Number.
I understand that the Utah Motor Vehicle Identification Number must be permanently affixed to the vehicle in an accessible location
using the adhesive backing and rivets (provided by the Division of Motor Vehicles).
Applicant's name (print)
Applicant's address
Applicant's signature
Section 4 - Certification of Pre-Installation VIN Inspection
Only a DMV employee, designated contractor, Utah peace officer, licensed dealer, or a certified safety inspector (mechanic) may sign
below verifying that the officer or agent has physically inspected the above-described unit.
This is to certify that I have personally inspected the above-described unit and find the vehicle information to be correct.
Signature of officer or agent
Department, dealer, or station name
ID, badge, dealer, or license no.
Section 5 - Certification of Post-Installation VIN Inspection
Utah Vehicle Identification Number _______________________________________ has been properly affixed in accordance with the instructions
to the _____________________________________________________________________________________ of the vehicle described.
Signature of officer or agent
ID, badge, dealer, or license no.
Department, dealer, or station name
If you need accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 or
Telecommunications Device for the Deaf (801) 297-2020. Please allow three working days for a response.


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