Utah Statement Tax Details

If you are a U.S. taxpayer, there's a good chance you will have to file Form TC 569A at some point. This form is used to certify your foreign tax credit, and it's important that you complete it accurately and honestly. Failing to do so can result in penalties from the IRS, so it's best to know what this form is and how to complete it correctly. In this blog post, we'll explain what Form TC 569A is, who needs to file it, and how to go about completing it properly.

Here is some facts that may help you establish the amount of time it can take to complete the form tc 569a.

QuestionAnswer
Form NameForm Tc 569A
Form Length1 pages
Fillable?Yes
Fillable fields28
Avg. time to fill out5 min 55 sec
Other namesutah tc 569a form, utah state ownership, tc 569a form, ownership statement form

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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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