Form TC-853A at a glance
What it is: Form TC-853A (Rev. 10/12) from the Utah State Tax Commission is the Original and Supplement Application - Utah A and C.
Who signs: By signing you certify, under penalty of law and the penalties of perjury, that the information herein is true, correct, and complete.
A filled-in Form TC-853A example: a trucking company lists one truck
How to fill out Form TC-853A, box by box
Applicant, license year and Fleet Account number
Fill in the Name of applicant, the Business telephone number, the License year and the Fleet Account number.
Circle one: Non-Expiring, Exempt, Multi-Year or Intra-State.
If Intra-State circle one: MAR, JUN, SEP or DEC.
Business address, mailing address and Person to contact
Enter the Business street address (where records are kept - must be a Utah address), with the City, County, State and ZIP code.
Enter the Mailing street address, with the City, State and ZIP code.
Enter the Person to contact regarding application, with the Telephone number, City, State and Fax number.
Type of operation and identification numbers
Type of operation (check the ONE that applies): Common Carrier, Contract Carrier, Private Carrier, Rental Company, Utah Exempt or Property Tax Exempt Organization.
Enter the Federal identification number and the U. S. DOT number.
Each vehicle
For each vehicle, enter the Unit number, Year, Make, Name of owner, Vehicle Identification Number and Unladen weight.
Enter the Fuel from the Fuel Key: D-Diesel G-Gasoline GH-Gasohol P-Propane N-Natural.
Enter the Declared combined gross weight, the Axles/ Seats and the License plate number.
Enter the Date of purchase, the Purchase price and the Factory price.
Mark Plate, Title or Temp.
Enter the USDOT number.
Mark Y/N **: Will the control and responsibility for the safety of this vehicle be assigned to a different Motor Carrier during the registration year by lease?
Deletions
Under Deletions, enter the Unit number, Plate and VIN.
Signature
Under Utah Special Fuel, by signing you certify that you have qualified with the Utah State Tax Commission and that you will make reports as required, under the federal identification number listed on this form.
Sign on the Signature line and enter the Date.
More rules for Form TC-853A
Division of Motor Vehicles, PO Box 30412, Salt Lake City, UT 84130, 801-297-7780 or 1-800-368-8824.
Sources
[1] Form TC-853A (Rev. 10/12), Original and Supplement Application - Utah A and C, Utah State Tax Commission (the Official source link on this page).