Utah State Tax Commission
Clear form
TC-840 Rev. 9/07
Relinquished Personalized Plates and Reassignment
Division of Motor Vehicle, 210 North 1950 West, Salt Lake City, Utah 84134, (801) 297-7780, 800-DMV-UTAH, TDD 297-2020
Plate Number Relinquished by Previous Owner
I hereby relinquish all rights to personalized plate number:
Print plate number here
Print previous registered owner name
Signed by previous registered owner
Date signed
New Owner Application (Please Print)
New owner name Address Plate type City Telephone number State Zip code
Life Elevated Skier
Life Elevated Arches
Pursuant to UC §41-1a-411(2), the DMV may refuse to issue any combination of letters, numbers or both that may carry connotations offensive to good taste and decency or that would be misleading.
Vehicle information where plate will be reassigned (must have current registration)
Current plate Expiration date Year Make VIN
IMPORTANT: All plates must be manufactured and all fees paid. As the registered owner of the vehicle on which they are to be displayed, I hereby make application for the personalized plate combination designated above. Failure of any vehicle owner to comply with the provisions of Utah Code §41-1a-413 concerning surrender of personalized license plates upon transfer, sale or disposal of a vehicle; or failure of any owner to register or renew registration of a vehicle using the personalized license plates issued for that purpose, shall constitute release by that owner of any priority for those personalized license plates; and the Motor Vehicle Division shall make that combination of letters and/or numbers available to the public. Checks should be made payable to the Utah State Tax Commission. Signed (new registered owner only) Date signed