Form TC-569B at a glance
What it is: TC-569B is the Repossession Statement of the Utah State Tax Commission.
Who signs: The repossessor signs on the Repossessor's signature line and writes the Date.
Where to get it: Division of Motor Vehicles, PO Box 30412, Salt Lake City, UT 84130; telephone 801-297-7780 or 1-800-368-8824.
A filled-in Form TC-569B example: a lien holder reports a repossessed trailer
How to fill out Form TC-569B, box by box
Section 1 - Vehicle Information
Under Section 1 - Vehicle Information, enter the Vehicle/Hull Identification Number (VIN/HIN), Year, Make, Model and Body type, then the License plate number, State last registered, Trailer length and Watercraft length.
Section 2 - Owner Information
Under Section 2 - Owner Information, write the Primary owner's name (last, first, middle initial, or business name), then the Street address (primary owner), City, State and ZIP code.
Write the Co-owner's name; if the co-owner is at a different street address, check here and list on back.
Write the Mailing address, if different from the Street Address (primary owner), with City, State and ZIP code.
Section 3 - Repossession Information and Signature
Under Section 3 - Repossession Information and Signature, enter the Recorded lien holder and the Date repossessed, then the Street address, City, State and ZIP Code.
Under penalties of perjury, you declare that you are the recorded lien holder or an authorized agent for the recorded lien holder for the vehicle and that you did lawfully repossess the vehicle under default, based on the conditions of the original agreement.
The repossessor signs on the Repossessor's signature line and writes the Date.
Section 4 - New Owner Information
Under Section 4 - New Owner Information, write the Primary owner's name (last, first, middle initial, or business name), then the Street address (primary owner), City, State and ZIP code.
For the new owner, write the Co-owner's name; if the co-owner is at a different street address, check here and list on back.
For the new owner, write the Mailing address, if different from the Street Address (primary owner), with City, State and ZIP code.
Common questions about Form TC-569B
Where do I file it?
Division of Motor Vehicles, PO Box 30412, Salt Lake City, UT 84130; telephone 801-297-7780 or 1-800-368-8824.
Sources
[1] Form TC-569B (Rev. 12/12), Repossession Statement, Utah State Tax Commission (the Official source link on this page).