Free TC-817, Application for Personalized Plates and Replacement of Existing Personalized Plates - Utah

Utah State Tax Commission

Application For Personalized Plates and Replacement Of Existing Personalized License Plates

Get forms online - tax.utah.gov

TC-817 Rev. 1/09

Use this form to order personalized license plates or to remanufacture your existing personalized license plates. This includes personalized standard plates, personalized special group plates, personalized disabled plates, and radio plates for use on an automobile, truck, trailer, or motorcycle. Personalized plates cannot be displayed on proportionally registered interstate vehicles. If you have any questions, please contact the Division of Motor Vehicles by calling (801) 297-7780 or 1-800-DMV-UTAH.

How To Complete Your Application
At the top of the application check whether this is an new plate order or replacement of existing plate. New Order: If you are registering your vehicle now, you must pay the registration fees, plate application fee, special group plate contribution, if applicable and provide information in Sections 1, 2 and either 3, 4 or 5. When selecting a special group plate, refer to pages two and three for additional fee information. If your vehicle is currently registered you must pay the plate application fee and special group plate contribution, if applicable and provide information in Sections 1, 2 and either 3, 4 or 5. When selecting a special group plate, refer to pages two and three for additional fee information. Personalized Plate Replacement: If you are replacing your existing personalized plates, your vehicle must have a current registration. Provide information in Sections 1, 2 and either 3, 4 or 5. The replacement fee is $13 ($10 plate replacement and $3 for postage and handling). Include a check or money order payable to the Utah State Tax Commission, along with the completed application form, and mail to the Utah State Tax Commission, Division of Motor Vehicles, Special Services, 210 N 1950 W, Salt Lake City, Utah 84134-8120. The $3 postage fee is already included in the plate application fee, but does not include the required contribution, if applicable. For minimum contribution requirements, see plate description on pages two and three. Accepting this application and payment of fees does not mean your personalized plate has been approved. Personalized plates are issued on a first-come, first-served basis. For this reason, if you have more than one choice, list your choices (except for Radio Plates), in order of preference, in case your first choice is not available, or not allowed under Utah Code §41-1a-411. Personalized license plates will be manufactured exactly as shown on this form. Utah Code §41-1a-411 allows the Division to refuse requests "that may carry connotations offensive to good taste and decency or which would be misleading." Any changes made to your personalized plate application after it has been submitted will require you to complete a new personalized plate application and pay all required fees again. IMPORTANT, PLEASE READ ABOUT SECTIONS 3 AND 4 In the space provided, you need to briefly explain the meaning of the characters you choose. For example, if the characters you chose are "LV2READ" they could mean, "Love to read." When making your character selection, do not use a combination of 6 or 7 numbers. For example, do not use consecutive numbers like "1234567." When making your character selection, do not use a combination of 3 numbers with 3 alpha characters. For example, do not use "123ABC or ABC123." These combination of numbers conflict with existing preprinted standard series of plates. When making your character selection, do not use a combination of 1 alpha character followed by 3 numbers and 2 alpha characters. For example, do not use "A123BC." When making your character selection, do not use a combination of 5 numbers and 1 letter. For example, do not use "12345A." No special characters (period, apostrophe, dash, etc.) may be used. All registered owners of the vehicle to which this personalized plate will be issued, have equal ownership of the personalized plate, regardless of which owner(s) has signed this application. Contact the DMV to order regular issue (non-personalized) special group or disabled license plates. If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 or TDD (801) 297-2020. Please allow three working days for a response. For additional information, you may access the Tax Commission's internet site at: http://dmv.utah.gov/

Page 1

Personalized License Plate Descriptions and Fees
Plate type Plate description, including contribution requirements

Fee includes $3 for postage and handling
Number of Plate characters application allowed fee*

Life Elevated Skier Life Elevated Arches Motorcycle Amateur Radio Boy Scouts

Any vehicle owner may request personalized plates. For standard personalized or disabled personalized plates. Any vehicle owner may request personalized plates. For standard personalized or disabled personalized plates. Any motorcycle owner may request personalized plates. Provide a copy of a current FCC license with assigned call numbers. Contribution of at least $25 yearly must be made to the Boy Scouts Of America. The first year contribution should be included with this application. Add to plate application fee for total due. Contribution of at least $25 yearly must be made to the Boys and Girls Club. The first year contribution should be included with this application. Add to plate application fee for total due. Contribution of at least $25 yearly must be made to the Children's Ad Litem Services Account and Children's Museum of Utah. The first year contribution should be included with this application. Add to plate application fee for total due. Requires a clean-fuel/clean-air permit issued by the Utah Department of Transportation to qualify for a clean fuel plate. The appropriate contribution must be made each year to the participating college or university of your choice. Add the appropriate contribution to the plate application fee for total due. If you made your contribution directly to a college or university, provide a copy of the Certificate of Fund Donation, form TC-836. For the appropriate contribution amount, see form TC-836 or dmv.utah.gov/licensecollegiate.html. A physician must complete a Physician Certification, TC-842. Available on Life Elevated Skier and Life Elevated Arches Plates. This plate does not qualify for parking in a disabled parking space. This plate is only available to qualified veterans who are disabled as a result of military service. Provide VA forms 20-5455 or a letter from a United States Military entity, certifying that the person is disabled as a result of military service. Requires a certificate of current EMT training. Provide completed farm truck affidavit or copy of your current farm truck registration. Contact DMV for other possible registration requirements. Provide a copy of a membership card from the Utah Firefighter Association or a letter from the local fire department or local governing body verifying that an individual is currently a full-time, part-time, volunteer, or retired firefighter. Provide a copy of discharge papers, notice of separation, or other acceptable government documents indicating a classification of prisoner of war. This plate is only available to a recipient of a Gold Star award issued by the U. S. Secretary of Defense. Applicant must provide one of the following written documents: document showing classification of death as listed by the U. S. Secretary of Defense, casualty report, telegram from the U. S. Secretary of Defense or one of the branches of the U. S. Armed Forces, or other documentation that verifies the applicant is a recipient of a Gold Star award. Contribution of at least $25 yearly must be made to No More Homeless Pets in Utah. Add to plate application fee for total due. Contribution of at least $35 yearly must be made to the Public Safety Honoring Heroes account. The first year contribution should be included with this application. Add to plate application fee for total due. Provide evidence of current membership in the Utah National Guard.

1 to 7 1 to 7 1 to 4 Call number 1 to 5

$58 $58 $58 $13 *$63

Boys and Girls Club Children's Issues Clean Fuel

1 to 5

*$63

1 to 5

*$63

1 to 5

$63

Collegiate

1 to 5

*$63

Disabled Person Disabled Veteran

1 to 5 1 to 5

$63 $63

EMT Farm Truck Firefighter

1 to 5 1 to 5 1 to 5 1 to 5

$63 $63 $63 $63

Former Prisoner of War Gold Star

1 to 5

$63

Homeless Pets Honoring Heroes

1 to 5 1 to 5 1 to 5 1 to 5 1 to 5

*$63 *$63 $63 $63 *$63

National Guard Pearl Harbor Survivor Public Education Support

Provide a copy of discharge papers, notice of separation, other acceptable government documents with dates and locations of active service, or evidence of a Pearl Harbor Survivor Association membership. Contribution of at least $25 yearly must be made to the Utah Association of Public School Foundations. The first year contribution should be included with this application. Add to plate application fee for total due. Purple Heart Provide a copy of discharge papers, notice of separation, other acceptable government documents with dates and locations of active service, or evidence of a "Military Order of the Purple Heart" organization Recipient membership. Physical possession of a Purple Heart Medal does not qualify for special group plate. Search and Rescue Provide official current Search and Rescue membership card, current Search and Rescue picture identification badge, or provide a letter (on county sheriff letterhead), from the county sheriff, stating that the applicant is a current Search and Rescue team member.

1 to 5

$50

1 to 5

$63

* A contribution is required in addition to the plate application fee. See plate description for required minimum contribution. Add the contribution amount to the plate application fee for total due.
Page 2

Continued - Personalized License Plate Descriptions and Fees
Plate type Plate description, including contribution requirements

Fee includes $3 for postage and handling
Number of Plate characters application allowed fee*

Search and Rescue Provide documentation verifying call numbers from the county sheriff. The applicant must be a Call Radio current Search and Rescue team member and must provide the same documentation required number to qualify for a Search and Rescue plate. Contribution of at least $25 upon first registration must be made to the Division of Parks and Recreation. Snowmobiler The first year contribution should be included with this application. 1 to 5 Add to plate application fee for total due. Contribution of at least $25 upon first registration must be made to the Department of Agriculture. Soil The first year contribution should be included with this application. Conservation 1 to 5 Add to plate application fee for total due. Vehicle must be 20 years old or older. Special Interest 1 to 5 Utah Housing Opportunity Veterans Contribution of at least $30. Available only to members of the Utah Association of Realtors. Must provide National or Utah Association of Realtors membership card or member verification letter on Utah Association of Realtor letterhead or one-time brochure tear-off card with member's name. Contribution of at least $25 upon first registration must be made to the Office of Veterans' Affairs. After the first year the yearly contribution is at least $10. The first year contribution should be included with this application. Add to plate application fee for total due. Vehicle must be 40 years old or older, used for club activities, exhibitions, tours, parades, occasional transportation and similar uses; but not for general daily transportation. Contribution of at least $25 yearly must be made to the Division of Wildlife. The first year contribution should be included with this application. Add to plate application fee for total due. Contribution of at least $25 yearly must be made to the Division of Parks and Recreation. The first year contribution should be included with this application. Add to plate application fee for total due. 1 to 5

$13

*$63

*$63 $63 $63

1 to 5 1 to 5 1 to 5

*$63 $84.50 *$63

Vintage Wildlife

Zion National Park

1 to 5

*$63

* A contribution is required in addition to the plate application fee. See plate description for required minimum contribution. Add the contribution amount to the plate application fee for total due. All plates, except for Amateur Radio, Vintage and Search and Rescue Radio require payment of an additional renewal fee of $10 when renewing plates for the next registration year. Do not include $10.00 fee in 1st time order. Pursuant to R873-22M-35, any personalized plate that has not been renewed within 6 months of its original expiration date, will be forfeited.

Page 3

Utah State Tax Commission

Clear form
Get forms online - tax.utah.gov

Application For Personalized Plates and Replacement Of Existing Personalized License Plates
Includes personalized, personalized special group, personalized disabled and amateur radio

TC-817 Rev. 1/09

New Order (payment and vehicle information is required) Complete Sections 1, 2 and either 3, 4 or 5. Personalized Plate Replacement (payment and vehicle information is required) Complete Sections 1, 2 and either 3, 4 or 5.

Section 1: Applicant Information Plates can be issued to and used only on the vehicle registered to the person(s) listed below
Check the type of vehicle plates will be used for Registered owner's name Date of application Motorcycle Trailer Automobile/truck/Van/Utility Daytime telephone number (required)

Mailing address

Is this a new address?

Yes

No City

State

ZIP code

Signature(s) X

If a contribution is required, enter the $ ____________ contribution amount

Section 2: Vehicle Information Current vehicle information for which personalized plates will be registered:
Current Utah plate no. Date registration expires VIN Make Model Year

When completing Section 3 or 4, you need to briefly explain the meaning of the characters you choose. For example, characters "LV2READ" could mean, "Love to read." Applications received without explanations may be rejected or denied. Note: All plates will be centered, unless clearly noted. Place characters in spaces as you would like them to appear on the plate.

Section 3: Personalized Life Elevated Skier or Arches Plates may use up to 4 characters (no special characters allowed)
Check the box for "Life Elevated Arches" or "Life Elevated Skier" plate design

Automobiles, trucks, trailers may use up to 7 characters and motorcycles

Life Elevated Arches

Life Elevated Skier

1st Choice
Explain the meaning of the characters you have chosen:

2nd Choice
Explain the meaning of the characters you have chosen:

3rd Choice
Explain the meaning of the characters you have chosen:

Section 4: Personalized Utah Special Group Plates

Use up to 5 characters (Slogan varies based on plate type) Check the special group plate you want (no special characters allowed)

Utah special group plate (specify type) American Legion, Boy Scouts, Boys & Girls Club, Children's Issues, Clean Fuel, EMT, Farm truck, Firefighters, Gold Star, National Guard, Homeless Pets, Honoring Heroes, Pearl Harbor, P.O.W., Public Ed. Support, Purple Heart, Search and __________________________ Rescue, Snowmobiler, Soil Conservation, Special Interest, Utah Housing Opp., Vintage, Zion National Park Veteran: Army Disabled Air Force American Legion Marine Navy Wildlife: Disabled: Trout Elk Bald Eagle L. E. Arches
College name

Collegiate

Coast Guard

L. E. Skier

1st Choice
Explain the meaning of the characters you have chosen:

2nd Choice
Explain the meaning of the characters you have chosen:

3rd Choice
Explain the meaning of the characters you have chosen:

Section 5: Amateur or Search and Rescue Radio Plate

(Plate characters are the assigned call numbers issued by the FCC or county sheriff. Use up to 6 characters)

See plate description on page 2 for requirements.