Form TC-895 "Application to Request a Motor Vehicle Account" - Utah

What Is Form TC-895?

This is a legal form that was released by the Utah State Tax Commission - a government authority operating within Utah. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2016;
  • The latest edition provided by the Utah State Tax Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form TC-895 by clicking the link below or browse more documents and templates provided by the Utah State Tax Commission.

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Download Form TC-895 "Application to Request a Motor Vehicle Account" - Utah

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Clear form
Utah State Tax Commission
TC-895
Division of Motor Vehicles • PO Box 30412 • Salt Lake City, UT 84130 • 801-297-7780 or 1-800-368-8824
Rev. 12/16
Application to Request a Motor Vehicle Account
Get forms at tax.utah.gov/forms
The following information must be submitted to the Division of Motor Vehicles in order to establish a Motor Vehicle Information Telephone
Account and/or a Utah Interactive Network Registration Agreement Account. Only applicants who satisfy the federal requirements for
access to motor vehicle records will be granted an account.
Note: Use form TC-890 to request release of protected motor vehicle information.
Section 1: Applicant Information
Applicant name
Company name
Mailing address
City
State
ZIP code
Street address (if different from Mailing address)
City
State
ZIP code
Federal ID number (required)
Phone (include area code)
Fax (include area code)
Email (required)
Section 2: Type of Account
Check the type of account you are applying for below:
Phone account: Monday-Friday, 8:00 A.M.-5:00 P.M. (excluding holidays); $3.00 per record
Title, Lien and Registration (TLR): Online, 24/7 access; $2.00 per record
Both Phone and TLR
Section 3: Reason(s) for Entitlement to Protected Motor Vehicle Information
Check the box that best describes why you are entitled to protected motor vehicle information under the Federal Driver’s Privacy Protection
Act (DPPA), Title 18, Section 2721. If the motor vehicle records you access are used contrary to DPPA standards, federal and state penal-
ties will apply.
For use by a government agency, including any court or law enforcement agency, in carrying out their functions or a private person or
entity acting on behalf of a government agency in carrying out its functions. (Provide a copy of the signed State contract if you are a
private person or entity.)
For use by a legitimate business or its agents, employees or contractors in the normal course of business to verify the accuracy of
personal information submitted by the individual to the business. (Provide a copy of a current business license. Explain in detail
what your business need is in the “Other” section below.)
For use by any federal, state or local court or agency connected with civil, criminal, administrative or arbitral proceedings.
For use by any insurer or insurance support organization, or by a self-insured entity, in connection with claims investigation activities,
anti-fraud, rating or underwriting.
For use to provide notice to owners of towed or impounded vehicles. (Provide a copy of a current towing business license.)
License number: _ _____ _ _ _ _ _ _ _ _ _ _ _ _ UDOT number: _____________ Location:_______ __ __ __
For use by an attorney for approved purposes provided by federal laws. (Provide a copy of a current license.)
License number: _ __ ___ __ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
For use by any licensed private investigative agency or licensed security service for approved purposes provided by federal law.
(Provide a copy of a current license for each individual that will be accessing records and list their names on the reverse side.)
License number:__ __ ___ _ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
For use by a new or used car dealer for purposes provided by federal law. (Out-of-state dealers must provide a copy of a current
license.)
License number: _ __ ___ __ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
Other (Provide a detailed explanation of your need.)
_ _ _ __ _ __ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ __ __ ___ _________________________ __ __ __ _
_ _ _ __ _ __ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ __ __ ___ _________________________ __ __ __ _
Clear form
Utah State Tax Commission
TC-895
Division of Motor Vehicles • PO Box 30412 • Salt Lake City, UT 84130 • 801-297-7780 or 1-800-368-8824
Rev. 12/16
Application to Request a Motor Vehicle Account
Get forms at tax.utah.gov/forms
The following information must be submitted to the Division of Motor Vehicles in order to establish a Motor Vehicle Information Telephone
Account and/or a Utah Interactive Network Registration Agreement Account. Only applicants who satisfy the federal requirements for
access to motor vehicle records will be granted an account.
Note: Use form TC-890 to request release of protected motor vehicle information.
Section 1: Applicant Information
Applicant name
Company name
Mailing address
City
State
ZIP code
Street address (if different from Mailing address)
City
State
ZIP code
Federal ID number (required)
Phone (include area code)
Fax (include area code)
Email (required)
Section 2: Type of Account
Check the type of account you are applying for below:
Phone account: Monday-Friday, 8:00 A.M.-5:00 P.M. (excluding holidays); $3.00 per record
Title, Lien and Registration (TLR): Online, 24/7 access; $2.00 per record
Both Phone and TLR
Section 3: Reason(s) for Entitlement to Protected Motor Vehicle Information
Check the box that best describes why you are entitled to protected motor vehicle information under the Federal Driver’s Privacy Protection
Act (DPPA), Title 18, Section 2721. If the motor vehicle records you access are used contrary to DPPA standards, federal and state penal-
ties will apply.
For use by a government agency, including any court or law enforcement agency, in carrying out their functions or a private person or
entity acting on behalf of a government agency in carrying out its functions. (Provide a copy of the signed State contract if you are a
private person or entity.)
For use by a legitimate business or its agents, employees or contractors in the normal course of business to verify the accuracy of
personal information submitted by the individual to the business. (Provide a copy of a current business license. Explain in detail
what your business need is in the “Other” section below.)
For use by any federal, state or local court or agency connected with civil, criminal, administrative or arbitral proceedings.
For use by any insurer or insurance support organization, or by a self-insured entity, in connection with claims investigation activities,
anti-fraud, rating or underwriting.
For use to provide notice to owners of towed or impounded vehicles. (Provide a copy of a current towing business license.)
License number: _ _____ _ _ _ _ _ _ _ _ _ _ _ _ UDOT number: _____________ Location:_______ __ __ __
For use by an attorney for approved purposes provided by federal laws. (Provide a copy of a current license.)
License number: _ __ ___ __ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
For use by any licensed private investigative agency or licensed security service for approved purposes provided by federal law.
(Provide a copy of a current license for each individual that will be accessing records and list their names on the reverse side.)
License number:__ __ ___ _ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
For use by a new or used car dealer for purposes provided by federal law. (Out-of-state dealers must provide a copy of a current
license.)
License number: _ __ ___ __ _ _ _ _ _ _ _ _ _ _ Expiration date:_____________
Other (Provide a detailed explanation of your need.)
_ _ _ __ _ __ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ __ __ ___ _________________________ __ __ __ _
_ _ _ __ _ __ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ __ __ ___ _________________________ __ __ __ _
TC-895_2
Application to Request a Motor Vehicle Account
Terms and Conditions
Please read these terms and conditions carefully
before signing and submitting your application.
The Utah State Tax Commission reserves the right to notify the
3. Maintenance of Records and Audit: The Applicant or Adminis-
individual about whom protected information is requested.
trator agrees to take such steps necessary to ensure the privacy
of the records disclosed under this application. Such steps
As a condition of the disclosure of protected records, the Applicant
include instructions and directions that may be provided by the
expressly agrees to the following terms:
Division, the marking of all records as “confidential not to be
1. Responsibility: The Applicant assumes all responsibility for the
copied” and the maintenance of written documentation substan-
protected records of the Division that may be disclosed pursuant
tiating the basis for the access of each record. For example, if
to this application in accordance with Utah Code Ann. Section
access is made to verify the ownership of a vehicle based upon
41-1a-116, 63G-2-202 and the Federal Driver's Privacy Protec-
information supplied by the owner, the Applicant should have in
tion Act, Title 18, Section 2721.
its records an application, statement or consent signed by the
owner representing his or her interest in the subject vehicle.
2. Training: The Applicant agrees to designate an account adminis-
trator to perform all training required by the Division and to
The Applicant agrees to permit the Division reasonable access
ensure the access of all protected records is made in accordance
to all files or documentation pertaining to a disclosed record.
with this application.
Such access may be on an individual basis, such as an investi-
gation of a complaint, or an audit to determine the Applicant’s
The Applicant or Administrator agrees to notify the Division
compliance with the applicable laws and procedures of the
of any change in the designated administrator and/or
Division.
authorized individuals that will utilize this access within 10
business days from such change. Changes must be on
4. Limited Use of Records: The Applicant warrants and
agency letterhead and signed by the Applicant or Administrator.
represents the protected records of the Division will only be
You may fax these changes to: (801) 297-7697, Attn: Third Party
accessed for the purpose marked on this application and that
Representative; or email dmvtlrsearch@utah.gov.
such records will not be used, disclosed or disseminated for any
other purpose, including advertising or solicitation purposes in
The Applicant or Administrator agrees to submit the names of all
any form. The Applicant understands that the improper use,
employees that will be utilizing the DMV Information Account with
disclosure, or dissemination of records accessed under this
this application. The Applicant or Administrator agrees to
application may violate applicable law and result in criminal
notify the Division in writing of any changes to the list of
sanctions and civil liability.
employees within 10 business days of such change. Chang-
es must be on business letterhead and signed by the Applicant or
5. Indemnification: The Applicant assumes responsibility for the
Administrator. You may fax these changes to: (801) 297-7697,
records disclosed and agrees to indemnify and hold harmless
Attn: Third Party Representative; or email
the Division from any and all claims, demands, actions or
dmvtlrsearch@utah.gov.
liabilities that may arise against the Division by reason of the
violation of the aforementioned statutes.
The Administrator will conduct any and all training of its employ-
ees and agents as directed by the Division. It is anticipated that
6. Termination: This application and the Applicant’s access to
training will be required on an annual basis or more frequently
records of the Division may be terminated and denied for any
depending upon the needs of the Division.
reason and at the sole discretion of the Division.
The Administrator shall require all employees, prior to access to
the protected records, to execute an acknowledgment that states
substantially as follows:
I understand that access to DMV records may only be made in
connection with a legitimate business need of the business as
permitted by law. Access of records for an improper purpose,
including personal reasons, is prohibited and subject to penalties
imposed by law. I am responsible for all IDs and passwords
issued to me and will protect them from unauthorized use. If I
learn of any improper use or disclosure of records, I shall report
such use or disclosure immediately to my supervisor and DMV.
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ _______ ________________________
Applicant name (print)
Title
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ _______ ________________________
Applicant signature
Date
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ _______ ________________________ _ __ __ __ _
Designated administrator name (print) *must be filled out and signed
Designated administrator signature
Date
Please allow seven working days for review and processing of your application. You will be notified by mail that your application
has been approved or denied, or if more information is needed.
Provide names of those individuals who will be utilizing your motor vehicle account below.
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ __________________________________ __ __ __
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ __________________________________ __ __ __
_ _ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ __________________________________ __ __ __
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