Form Tc 569A PDF Details

The TC-569A form, known as the Ownership Statement, serves a critical role within the Utah State Tax Commission's Division of Motor Vehicles for facilitating vehicle ownership documentation and is designed to streamline the legal processing of vehicles in the state. This comprehensive form requires detailed information about the vehicle—including its year, make, model, Vehicle/Hull Identification Number (VIN/HIN), body type, and license plate number—in Section 1, ensuring that all pertinent vehicle specifications are accurately recorded. In tandem, Section 2 gathers essential details on the owner(s), such as names, email addresses, street and mailing addresses, strengthening the connection between the vehicle and its legal owner. The form further delves into the financial aspect of the vehicle's ownership in Section 3, asking for the value of the vehicle, purchase price, and the date of purchase, with a specific clause about the necessity of a surety bond if the vehicle's fair market value exceeds $1,000. An integral part of this document is the indemnification agreement, which demands the owner to acknowledge the vehicle’s status concerning liens, encumbrances, lawful claims, demands, and litigation, thus ensuring full transparency and accountability in the vehicle's ownership status. The form concludes with an imperative legal attestation signified by the owner's signature, asserting the truthfulness and completeness of the provided information under the penalties of perjury, alongside a section dedicated to official use that includes checks against the National Crime Information Center (NCIC) and the National Law Enforcement Telecommunications System (NLETS) to validate the vehicle's legal status. This well-structured form encapsulates a meticulous approach to documenting vehicle ownership, blending legal, financial, and personal information to uphold both state regulations and the interests of the vehicle owners.

QuestionAnswer
Form NameForm Tc 569A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesownership statement form, ownership statement sample, utah ownership, tc 569a

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Utah State Tax Commission

Division of Motor Vehicles • PO Box 30412 • Salt Lake City, UT 84130 • 801-297-7780 or 1-800-368-8824

Ownership Statement

TC-569A

Rev. 11/20

Get forms at tax.utah.gov/forms

Section 1 - Vehicle Information

 

Year

Make

Model

Vehicle/Hull Identification Number (VIN/HIN)

Body type

 

 

 

 

 

 

 

 

 

License plate number

State last registered

Trailer length

Watercraft length

 

 

 

 

 

ft _____in____

ft ____in ____

 

 

 

 

 

 

 

 

 

Section 2 - Owner Information

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary owner’s name (last, first, middle initial, or business name)

Email address

 

 

 

 

 

 

 

 

 

 

 

 

Co-owner’s name (if at different street address, check here and list on back)

Email address

 

 

 

 

 

 

 

 

 

 

 

 

Street address (primary owner)

 

City

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

Mailing address, if different from street address (primary owner)

City

 

State

ZIP Code

 

 

 

 

 

 

 

 

Section 3 - Facts and Indemnification Agreement

Value of vehicle

Purchase price

$

$

 

 

Date of purchase

If the fair market value of the vehicle exceeds $1,000, a surety bond may be required, not to exceed twice the fair market value of the vehicle. This value may be reassessed by the Division during the application process.

Explain why outstanding certificate of title was not obtained or why the attached certificate of title is not valid. Explain in detail how, where, and when you acquired the vehicle, who was involved, the condition of the vehicle, and any other information regarding the vehicle:

Under penalties of perjury, I declare that to the best of my knowledge and belief, this statement 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 is not involved in any existing or pending litigation. I agree to indemnify the Utah State Tax Commission and all persons acting under direction of the Commission, from any and all liability and shall defend all litigation that may arise as a result of the issuance of a certificate of title in my name.

Signature of applicant

X

Date

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

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You need to provide the required details in the Section Facts and, Purchase price, Date of purchase, If the fair market value of the, Explain why outstanding, Under penalties of perjury I, Signature of applicant, For Office Use Only NCIC Check, No Hit Found, Hit Found, Partial Hit Found, Date, OfficerAgent name, IDBadge number, and Agency name space.

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