How to fill out Utah TC-569D

One page, one enormous box, and a perjury clause. It is the Division's general-purpose explanation form: a vehicle identified at the top, a person or company identified in the middle, and then a Statement field deep enough to swallow several paragraphs. A private seller reaches for it when something about the paperwork needs saying out loud - two spellings of one name, a signature written in the wrong lane, a purchase price that was recorded wrongly - and the Division also names it for a use nobody would guess: recording that a vehicle has been restored and modified with modern emissions control technology.

Written against TC-569D (Rev 11/20), issued under Utah Code 41-1a-512. The certification is the same penalties-of-perjury clause the ownership statement carries, and it is what makes a written explanation acceptable at a counter at all. Treat the box as evidence rather than as a covering letter: dull, specific and dated beats fluent every time.

Two documents, and they are not the same thing. Take the blank TC-569D from the files.tax.utah.gov copy so you get the revision that is current today.

Every line, in the order you meet it

1. 1
   You fill this in

   Section 1, the vehicle

   Year, make, model, identification number, body type, plate number and the state it was last registered in.

   Watch out: Fill in the plate as well as the identification number. It is what lets a clerk pull the live record rather than searching for the vehicle.

2. 2
   You fill this in

   Section 2, who is speaking

   Your name and email, or the company name and its email if the statement is a business's.

   Watch out: One statement, one voice. If a seller and a buyer each need to explain something, that is two forms.

3. 3
   You fill this in

   The Statement box

   What happened, in as much detail as it takes.

   Watch out: Name the documents. A clerk holding a title that says one name and a licence that says another wants a sentence that quotes both, not a sentence that says they are the same.

4. 4
   You fill this in

   Signature and date

   One signature under the perjury declaration, with the date.

   Watch out: There is no notary line and none is wanted. What gives the statement its weight is the declaration printed above the signature.

What gets this one rejected

• •Left unsigned. Without the signature the perjury declaration is unmade and the page is a note rather than a statement.
• •Used to correct an odometer reading on a document that has already been signed. A false or altered mileage certification is not repaired by a second document explaining it.
• •A statement about a vehicle it does not identify. The whole of Section 1 exists so a clerk can attach the explanation to a record.
• •Two unrelated problems on one sheet. It is read as a single sworn statement, and a second issue deserves a second form.
• •Vagueness. A clerk is reconciling two documents, so a statement that names what each of them says beats an apology or a general assurance.
• •Signed by somebody the statement is not about. The name in Section 2 and the signature at the foot are the same person.

Rules that decide whether it is accepted

• •It supplements a packet, it never replaces a document. Nothing on this page transfers ownership, releases a lien or discloses mileage. It travels with the documents that do those things and explains one thing about them.
• •It is also the restored-modified route. The Division's inspections page names this form for an owner who wants a statement on their registration certificate that the vehicle has been restored and modified with modern parts and technology, including emissions control technology and an on-board diagnostic system.

Every line here was read off TC-569D (Rev 11/20) itself — the PDF is here — and off the Utah State Tax Commission, Motor Vehicle Division pages. This is plain-language help with a form, not legal advice, and where our wording and the agency's differ, theirs governs.

Back to all Utah seller paperwork, or what selling a car in Utah involves.