Requestor’s name
Requested vehicle record plate number, VIN ,or
owner's name
For use by any licensed private investigative agency, licensed security service, or attorney for purposes provided
by law - must provide a copy of the written contract if under contract to provide any of the services listed below.
For use by any requestor with a written consent or Power of Attorney from the owner of record - must submit
a copy of the written consent or Power of Attorney.
For use by any requestor for service of process or in connection with an order of a court - must submit a copy
of the summons or court order.
For use by any insurer or insurance support organization, or by a self-insured for entity claims investigation activities.
For use to provide notice to the owner of a vehicle under one of the following circumstances:
For use by any requestor who is the owner of record, or in the case of an incorporated business, an officer of the corporation.
For use by a government agency, including any court or law enforcement agency, in carrying out their functions.
Other (please explain)
License number: ____________________ Expiration date: ____________________
Tower business license number: __________________.
State: ____________.
State: ____________.
Repairman’s business license number: __________________.
Identifying number from picture ID: _____________________. ID issued by ___________________________.
Identifying number from government-issued picture ID _____________________. ID issued by ___________________________.
Case file name and number __________________________.
Insurance organization name _______________________________.
Court case or investigative file number _____________________.
See attached list
Fax ($4 each record)
Out-of-state search ($3 each record)
Mail ($3 each record)
Mail Microfilm ($6.50 each record)
Check one of the following boxes that describes why you are entitled to protected motor vehicle information as permitted by Utah Code Section
41-1a-116, 63G-2-201 and the Federal Driver’s Privacy Protection Act (DPPA), U. S. C. Title 18 Chapter 123 Section 2721.
This
information may only be used in one of the ways listed below and .
If you are faxing or
mailing your request and do not have a DMV Information Account, you must include a copy of your license and/or identification.
cannot be used for debt collection, asset recovery, or skip tracing purposes
Company
DMV Information Account Number
Date signed
X
Requestor’s address ( )this release is not complete without street, city, and ZIP
Justification Statement (this document must be signed below)
Requestor’s Signature
Requestor’s signature
* The Tax Commission reserves the right to notify the individual about whom protected information is requested.
As the requestor of this information and the signer of this form, I assume all responsibility for the protected motor vehicle record(s) I am requesting as outlined in
Utah Code Sections 41-1a 116 and 63 -2-202, and the Federal Driver's Privacy Protection Act, U. S. C. Title 18 Section 2721. I affirm that I am
entitled to this information pursuant to the reason(s) marked above; and acknowledge that the information requested can only be used for the purpose stated on
this application; and this information may not be disseminated or disclosed for any other purpose, including advertising or solicitation purposes. Dissemination or
disclosure may violate Utah Code 6 -2, and U. S. C. Title 18 Chapter 123. As a condition of the disclosure of the records requested in this
application, I assume responsibility for the records disclosed and agree to indemnify and hold harmless the Division of Motor Vehicles from any and all claims,
demands, actions or liabilities that may accrue against the Division by reason of the violation of the aforementioned statutes.
- G Chapter 123
3G 53-9-116
For use by a legitimate business, in the normal course of business, to verify the accuracy of personal and vehicle information
submitted by the owner of record.
Check
one:
I am a dealer (Dealer no. or FEIN: _________________)
Vehicle towed or impounded - must provide a copy of the tow bill.
Vehicle potentially subject to a Repairman’s Lien - must provide a copy of the signed work order.
Vehicle potentially subject to a Storage Lien - must provide a copy of the signed rental/lease agreement.
Mobile home abandoned or in default of rental/lease agreement - must provide a copy of the signed rental/lease agreement
and a statement explaining the park owner’s efforts to locate the owner of record.
I am a financial institution (FEIN: __________________)
I am a motor carrier and am listed on the motor vehicle record (DOT no. or FEIN: __________________)
Telephone:
Fax:
Current plate (Office Use Only)
DL state
If out-of-state record search is requested, a VIN inspection is required (TC-661)
If you checked this box, you must explain how the request is supported through the DPPA by selecting an additional option
below or by providing additional documentation such as a court order, summons, complaint, etc.
Request type (check one)
Release of Protected Motor Vehicle Information
Utah State Tax Commission
TC-890
Rev. 12/13
Get forms online - tax.utah.gov
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824
Requestor's driver license no. or FEIN, if business
