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Show Form TC 115 STATE TAX COMMISSIO N Do not write in this s pace (Date Stamp) STATE OF UTAH CJ > j;f ::a Ill n 0 < STOL EN AUTO MOBI LE REPO RT Ill 0 To be filed with the State Tax Commission, 118 State Capitol, Salt Lake City, by peace officers of all jurisdictions immediately upon receivi information that a motor vehicle has been stolen or unlawfully tak n. _ _____ _____ ____________ Occupatio n _____ ___ Owner __ Address --------- ------~-- --------- --------- City MAKE OF AUTOMOBIL E J / . MOTOR -,. .J. ________________________________________________________ _______________..________ Co unty SERIAL .. ..... - J State MODEL T Y PE OF BODY ( YEAR No. NEW , USED OR REBUILT .,,_ ... Purchased From ____________________________ -------------------------------------- Ad dress:______________________________________ ___ Date______ _ License No. _____________________________________________________________ year 19 3 ________ state of ____________________ .,J _____________ _ _ _ _ _ __ _ _ _ __ _ Date of Theft__ ___~----•--------------"-----='--~-~---:-----~--------------- 19 3 ________Time of Theft ______________________________ _______________________________ Place of Theft (City) ______ _ ______ _Location of Theft__ _______________ ~-------------- -------~-------------- When we re Po 1ice No tif ie d-----'--'----------------------------------------- _______ Where _______ ---------------------------Color of Body __________________________ - - - - - ~ - - - --Condi tion of Paint______________ _ Color of Wheek_..L_______________ - .,....---.. -~ _ _______________Wire, Disc or Wood---------~---------- --- I Kind- of ToP- - ---1------------------------------ ________________________ Color of Upholster ing _______________ ___ _ Specify shape of glass i n ~ o f : q ; ~ e s _________________________ _ Tires: Specify make, size, description and serial nl.lmbets: Left Front _________________________ ·_____________ _ _ _ _ _ _ ____._ ight Front _________ _______ ________ Left Rear____________________.::._' - - - ----------------- Right Rear ____________ _____ Spare ________________________________ - _______ _ Extra Equipment__ _____________________________________ _ Special marks of identificat ion, such as scratches, dents, etc. --------'-'------------------. ______ _________________________________ ,__ _____ _____ --------------------- --------------------- -------------·------ - - - ----- --------- Cont en ts of car, if any, when stolen __________________________ _.______ ---------------------------- ' \.. --,-------~-- _...c..._.:_:; _ " Office Reporting _______ c ---------------------------------------. _______ ___ By--------------------------- - ------------·~-··------------------------------ ------------Cl |
