Exemption of Utah Safety and Emission Requirements For Vehicles Not in Utah
Exemption of Utah Safety and Emission Requirements For Vehicles Not in Utah
Exemption of Utah Safety and Emission Requirements For Vehicles Not in Utah
WARNING: Providing false or misleading information on this form is a crime, subject to penalty under Utah Criminal Code 76-8-504.
Section 1 - Vehicle Information
Year Make Model Vehicle Identification Number (VIN) Fuel Utah plate number
I understand that under Utah Code my vehicle may be required to pass a state safety inspection prior to registration in the State of Utah.
If I am a resident of Cache, Davis, Salt Lake, Utah, or Weber County, my vehicle may be required to pass an emissions inspection prior
to registration. I hereby certify that the above-described vehicle is temporarily out-of-state and is now located at:
This vehicle is temporarily in a state shown in Section 1A on the reverse side of this form. If so, you must obtain and enclose a
certificate of safety inspection, or equivalent, from the state where the vehicle is located. You must keep a copy of the
certificate in the vehicle and present it if requested by an officer.
This vehicle is not located in a state shown in Section 1A on the reverse side of this form. I affirm and agree that the vehicle will
be kept in a safe mechanical condition and that upon returning to the State of Utah, I will have the vehicle safety inspected. I will
keep a copy of the certificate in the vehicle and present it if requested by an officer.
Section 3 - Emissions Inspection
When in Utah, I am not a resident of Cache, Davis, Salt Lake, Utah, or Weber County. No emissions test is required.
When in Utah, I am a resident of Cache, Davis, Salt Lake, Utah, or Weber County and this vehicle is temporarily located in a city,
county, or state area shown in Section 2A on the reverse side of this form. If so, you must include a certificate of emissions,
inspection, or equivalent, from the city, county, or state where the vehicle is located. Keep a copy of the certificate in your vehicle.
When in Utah, I am a resident of Cache, Davis, Salt Lake, Utah, or Weber County and this vehicle is not located in a city, county, or
state area shown in Section 2A on the reverse side of this form. I affirm and agree that I will have the vehicle tested for emissions and
will submit proof of the emissions inspection to the Department of Health in the county in which I reside within 10 days after the
return to Utah" date shown above.
IMPORTANT INSTRUCTIONS: At the time of vehicle registration, return this completed form with the renewal documents and
all required fees to the Division of Motor Vehicles (do not send cash in the mail). If you have questions about this form, please
call (801) 297-7780 or 1-800-368-8824. The vehicle owner is responsible to retain a copy of this completed form in the vehicle
and to submit a copy of this completed form to the appropriate county health department listed below.