Vadrs Logon Request

Download a blank fillable Vadrs Logon Request in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Vadrs Logon Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Clear form

Utah State Tax Commission

TC-896

VADRS Logon Request

Rev. 02/16

Please email completed form to the Division of Motor Vehicles at

officesupport@utah.gov

or fax to 801-297-7697

Section 1- Completed by requestor

Check one:

Add new user

Change security group/office

Delete user

Re-enable User ID

Name: ________________________________

Email Address: _____________________________________

Job Title: ______________________________

Phone: ________________________________

Agency/Office: ________________________________

Office Mailing Address: _______________________________________________________________________

Date change should be effective: ________________________________

By signing this application for access to the Utah State Tax Commission computer systems, I acknowledge that I have read and understand the following

policy statement and I agree to adhere to it.

I am applying for access to one or more computer systems. I understand that this access is granted solely in conjunction with my assigned duties as an

employee or representative of the Utah State Tax Commission. I am responsible for all ID’s and passwords issued to me and will protect them from

unauthorized use. By accessing and using this government system, you are consenting to system monitoring for law enforcement and other purposes.

Unauthorized use or disclosure of protected information is prohibited and may subject you to State and Federal criminal prosecution and penalties as

Applicants Signature: ___________________________________

Date: ___________________

(Entering name/Digital Signatures accepted)

Supervisor’s Signature: ___________________________________

Date: ___________________

(Entering name/Digital Signatures accepted)

Section 2- Completed by DMV Personnel

Security group:

County Emissions