Application For Special Plates And Decals Tc142
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Utah State Tax Commission
TC-142
Rev. 6/16
Application for Special Plates and Decals
Get forms at tax.utah.gov/forms
Please complete the following information. Use a separate form for each license type.
Company name: _ _ _ ___ _ __ ___ __ ___ __ _____________
License number: __________ _ __ __ _
Manufacturer
Transporter
Dealer
Dismantler
As owner, partner, or corporate officer of the above company, I am applying to the Utah State Tax Commission for the following items:
__ _ __ _ __ _ Dealer plates* ($12.00 each - includes decal).......................................................................... $_____ __ __ __
__ _ __ _ __ _ Motorcycle plates* ($12.00 each - includes decal)................................................................... $____ _ __ __ __
__ _ __ _ __ _ Dismantler, Manufacturer, or Transporter plates* ($10.00 each).............................................. $____ _ __ __ _ _
__ _ __ _ __ _ Renewal decals for Dealer plates ($10.50 each)...................................................................... $____ _ __ __ __
__ _ __ _ __ _ Renewal decals for Dismantler, Manufacturer, or Transporter plates ($8.50 each)................... $_____ _ __ __ _
*Handling fee required with each plates order ($2.50 for 1-2 plates, $3.50 for 3 or more plates)..............................$_____ __ __ __
Total: $____ __ __ __ _
Additional instructions:_ _ _ __ ___ ___ __ ___ _____________
Decal number (office use only):_ ___ ___ __ ___ _____________
Renewal decals are for plate numbers: __ __ ___ __ ____________
__ _ __ __ _ __ _ __ __ __ __ ___ __ ___ _____________
__ _ __ __ _ __ _ __ __ __ __ ___ __ ___ _____________
I, the undersigned, being duly sworn, depose and say that I have applied for a license to engage in the business shown above, and I hereby
make application for special license plates. The license plates will not be used on any vehicles other than the vehicles authorized under the
provisions of the law.
I further certify, under penalty of law, that all vehicles operated, displaying such special plates, will be insured as prescribed by
law.
Insurance company: _ _ ___ _ ___ ___ __ ___ ______________
Policy number: __________ _ __ __ __
Address: _ __ _ __ _ _ __ _ __ __ ___ ___ __ _____________
Phone:_______________ __ _ __ _
Note: You must submit a current copy of your plate insurance declaration every time you order or renew plates. Insurance must be issued in
the name of the licensed business.
__ _ __ _ __ _ _ __ _ _ __ ___ ___ __ ___ ______________
__________________ _ __ __ _
Signature (must be signed by owner, partner, or corporate officer or
Firm name
signer designated by POA on file with MVED)
__ _ __ _ __ _ _ __ _ _ __ ___ ___ __ ___ ______________
__________________ _ __ __ _
Printed name of signer
Date
Return application and fees to:
Utah State Tax Commission
Motor Vehicle Enforcement Division
210 North 1950 West
Salt Lake City, UT 84134
Phone: 801-297-2600
Make check or money order payable to Utah State Tax Commission.
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