Tc 853A Form PDF Details

Need to submit the Tc 853A form? Trying to figure out how and when it needs to be done can seem overwhelming, but don’t worry - we’re here to help! In this blog post, we'll explain what the Tc 853A is, why you may need it and other key information. Through our straightforward tips, tricks and explanations you'll soon master this important form with ease.

QuestionAnswer
Form NameTc 853A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namestt, utah form tc 853a, Utah, tc 853a

Form Preview Example

UTAH STATE TAX COMMISSION

Original and Supplement Application - Utah A and C

TC-853A

REV. 10/12

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

 

Motor Carrier Services · 801-297-6800 or 1-800-251-9555; Fax: 801-297-6899

 

 

 

 

 

 

 

 

 

 

 

Get forms online - tax.utah.gov

Name of applicant

 

 

 

 

 

 

 

 

 

 

 

Business telephone number

 

 

 

 

 

 

License year

 

Fleet

 

 

 

Account number

 

 

 

 

Circle one

If Intra-State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UT-

 

 

 

 

Non-Expiring

circle one

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business street address (where records are kept - must be a Utah address)

 

 

 

Mailing street address

 

 

 

 

 

 

Person to contact regarding application

 

 

Telephone number

Exempt

MAR

JUN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Multi-Year

SEP

DEC

City

 

 

 

 

County

 

 

 

State

ZIP code

City

 

 

 

 

 

 

 

State

ZIP code

 

City

 

 

 

 

 

 

 

State

Fax number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Intra-State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of operation (check the ONE that applies)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal identification number

 

 

U. S. DOT number

 

 

 

 

Common Carrier

 

 

Contract Carrier

 

 

Private Carrier

 

 

Rental Company

 

 

 

Utah Exempt

 

 

Property Tax Exempt Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Use Only

 

 

 

number

 

 

 

 

 

 

 

 

 

 

 

 

Fuel

weight

 

Declared

Axles/ Seats

 

 

 

purchase

 

price

 

 

Plate

Title

 

Temp.

License

number

 

Property

Dealer name or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

gross weight

 

 

 

 

 

 

 

number

 

 

 

 

Unit

Year

Make

Vehicle Identification Number

 

 

 

Unladen

 

combined

 

 

Name of owner

Date of

Purchase

Factory

 

 

 

 

plate

USDOT Y/N

 

tax

previous license Verified by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

price

 

 

 

 

 

 

 

**

1 yr. 2 yr.

number year

 

 

 

 

 

 

 

 

 

 

 

 

 

Deletions

 

 

 

 

** Will the control and responsibility for the safety of this vehicle be assigned to a different Motor Carrier during the registration year by lease?

 

 

 

 

 

 

 

 

Unit

Plate

VIN

My signature below acknowledges that under penalty of law, I certify, under the penalties of perjury, that the information herein is true,

 

 

OFFICE USE ONLY

number

 

 

 

 

correct, and complete.

 

 

 

 

 

 

 

 

 

 

 

 

HVUT verified ________________________

 

 

 

Utah Special Fuel: I hereby certify that I have qualified with the Utah State Tax Commission and that I will make reports as required,

 

 

 

 

 

 

 

 

 

 

 

 

under the federal identification number listed on this form.

I/M verified __________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fuel Key:

D-Diesel

P-Propane

GH-Gasohol

 

 

 

 

 

 

 

 

 

 

 

 

 

G-Gasoline

N-Natural

 

 

 

 

 

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Filling in segment 1 in UTPerson

2. Your next step would be to complete these particular blank fields: Deletions, Unit, number, Plate, VIN, Will the control and, My signature below acknowledges, OFFICE USE ONLY, Utah Special Fuel under the, I hereby certify that I have, HVUT verified, IM verified, Signature, Date, and Fuel Key.

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