Utah State Tax Commission
Certificate Of Inspection
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824 |
Get forms online - tax.utah.gov |
|
|
Any Alteration or Erasure Will Void This Document.
Units registered in the State of Utah for the first time (except new units sold by licensed and bonded Utah dealers) must be inspected to verify the vehicle/hull identification number.
Section 1 - Applicant Information
Name (last, first, middle initial, or business name)
Address (street, city, state, zip)
Section 2 - Vehicle/Vessel Information
Vehicle/Hull Identification Number (VIN/HIN) or serial number
VIN/HIN location |
|
|
|
|
|
Plate number |
Visible through windshield |
Body-right |
|
Trunk |
On engine |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State of issue |
Body-left (driver side) |
Engine compartment |
Frame |
Other: _______________________ |
|
|
|
|
|
|
|
|
|
|
|
Year |
Make |
|
Model |
|
|
Body style |
|
Cylinders |
|
|
|
|
|
|
Fuel type |
Engine size |
|
Length (trailers and watercraft) |
Hull material (watercraft) |
|
HP________ CC________ |
|
ft________ in________ |
|
|
|
|
|
|
|
|
|
|
|
|
Propulsion type (watercraft)
Section 3 - Inspection Certification
Only a DMV employee, designated contractor, Utah peace officer, licensed dealer or a certified safety inspector may sign below verifying that the officer or agent has physically inspected the identification number (VIN/HIN) as it appears on the unit. Inspection by out-of-state peace officers and authorized agents of other state motor vehicle offices will be accepted.
This is to certify that I have personally inspected the unit described above and find the description to be correct.
Signature of officer or agent |
|
|
|
|
|
Date |
|
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Department, dealer or station name |
|
|
|
|
|
ID, badge, dealer or license no. |
For Office Use Only |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NCIC Check |
|
|
|
|
|
|
|
|
|
|
|
No Hit Found |
|
|
Hit Found |
|
Partial Hit Found |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Officer/Agent name |
|
|
|
|
|
Agency name |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ID/Badge number |
|
|
|
|
|
Date |
NLETS Search |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 - State |
|
50 - State |
|
No Record Found |
|
|
Record found in: ______________________________________________ |
|
|
|
|
|
Officer/Agent name |
|
|
|
|
|
Agency name |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ID/Badge number |
|
|
|
|
|
Date |
|
|
|
|
|
|
|
|
|
|
|
|
|