Utah State Tax Commission
Application for Special Plates and Decals
Return application and fees to : |
Motor Vehicle Enforcement Division |
|
210 North 1950 West |
|
Salt Lake City, UT 84134 |
|
Telephone: 801-297-2600 |
Make check or money order payable to Utah State Tax Commission
Please use a separate form for each license type.
Company name: _____________________________ License number: ____________
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 vehicle 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 _____________________________________ |
Telephone number ____________ |
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 the name of the licensed business.
______________________________
Firm name
______________________________
Signature (must be signed by owner, partner or corporate officer or signer designated by POA on file with MVED)
______________________________
Printed name of signer
______________________________