Form Tc 569A PDF 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.

Form NameForm Tc 569A
Form Length1 pages
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


Rev. 11/20

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Section 1 - Vehicle Information





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)





ZIP Code










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




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



For Office Use Only

NCIC Check



No Hit Found

Hit Found

Partial Hit Found

Officer/Agent name

Agency name

ID/Badge number


NLETS Search




10 - State

50 - State

No Record Found

Record found in: ________________________

Officer/Agent name

Agency name

ID/Badge number


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part 1 to filling in tc 569a form

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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