TC-810, Exemption Affidavit of UT Safety and Emissions
Clear form Utah State Tax Commission Division of Motor Vehicles, PO Box 30412, Salt Lake City, UT 84130 TC-810 Rev. 6/10 Exemption Affidavit 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. Return completed and signed form with the renewal documents or with registration applications and necessary fees (do not send cash in the mail). If you have questions about this form, telephone 801-297-7780 or 1-800-368-8824 outside the Salt Lake City area. I, the undersigned, understand that under Utah Code I am required to have my vehicle safety inspected and tested for emissions in Davis, Salt Lake, Utah, or Weber Counties prior to registration in the State of Utah. I hereby certify that the following described vehicle is temporarily out of state and is now located at: ___________________________________ ____________________________ _________________ Physical address (not P.O. Box) City _________ ___________ State ZIP code County as a result of _________________________________ and will return to Utah on month _______ day _______ year ______ , and I am unable to meet the above requirements. I further certify and agree to the following: You must check one box in each section that applies to your out-of-state location. Section 1 - Safety Inspection This vehicle is temporarily in a state shown in Section 1A on the reverse 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 when 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 when requested by an officer. Section 2 - Emissions Inspection When in Utah, I am not a resident of Davis, Salt Lake, Utah, or Weber County. No emissions test is required. When in Utah, I am a resident of 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 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. This vehicle is fueled by diesel and is not part of a fleet licensed under the International Registration Plan. 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. Salt Lake Valley Health Department 788 E. Woodoak Lane #150 Murray, Utah 84107-6379 801-313-6720 Year Make Weber - Morgan Health Department 477 23rd Street Ogden, Utah 84401 801-399-7140 Model Fuel Utah County Health Department Bureau of Air Quality Program 3255 North Main Street Spanish Fork, Utah 84660 801-851-7600 Utah plate number VIN Owner's name Owner's UTAH street address Davis County Environmental Health County Courthouse P.O. Box 618 Farmington, Utah 84025 801-451-3296 New expire. date Telephone number City County ZIP code State UT Owner or authorized representative's signature Date X IMPORTANT INSTRUCTIONS: This form must be submitted to the Division of Motor Vehicles at the time of vehicle registration. 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 above. Both the safety and emission inspections must be completed by the jurisdiction where the vehicle is located, before a vehicle can be registered in Utah. Section 1A - States As of 2010, the areas listed below must meet EPA standards. Section 2A - Jurisdictions Requiring Safety The list below would not reflect changes by EPA after this printing. Requiring Emission Inspection Inspection Delaware District of Columbia Hawaii Louisiana Maine Massachusetts Mississippi Missouri New Hampshire New Jersey New York North Carolina Pennsylvania Rhode Island Texas Utah Vermont Virginia West Virginia AK (Gas) Anchorage: Anchorage Fairbanks: North Star AZ (Gas, Heavy Duty Diesel) Phoenix: Apache Junction Gold Canyon Maricopa Pinal Yavapai Tucson: Pima CA (Gas) Statewide CO (Gas, Light & Heavy Duty Diesel) Denver: Adams Arapahoe Boulder Broomfield Denver Douglas Jefferson CT (Gas, Heavy Duty Diesel) Statewide DC (Gas) District-wide DE (Gas) Wilmington: New Castle Kent Sussex GA (Gas) Atlanta: Cherokee Clayton Cobb Coweta Dekalb Douglas Fayette Forsyth Fulton Gwinnett Henry Paulding Rockdale ID (Gas, Light & Heavy Duty Diesel) Boise: Ada IL (Gas) Chicago: Cook Du Page Kane Kendall Lake McHenry Will East St. Louis: Madison Monroe St. Clair IN (Gas) Chicago Subs: Lake Porter LA (Gas) Baton Rouge: Ascension East Baton Rouge Ibervile Livingston West Baton Rouge ME (Gas, Light & Heavy Duty Diesel) Statewide MA (Gas, Light & Heavy Duty Diesel) Statewide MD (Gas, Light & Heavy Duty Diesel) Baltimore: Anne Arundel Baltimore Calvert Carroll Cicel Charles Frederick Hartford Howard D. C. Subs: Montgomery Prince Georges Queen Anne' s Washington RI (Gas, Light & Heavy Duty Diesel) WA (Gas, Light & Heavy Duty Diesel) MO (Gas) Seattle: Statewide St. Louis: TN (Gas, Light Duty Diesel) Bellevue Franklin Memphis: Everette Jefferson Shelby Spokane St. Charles Nashville: Vancouver St. Louis Davidson Tacoma St. Louis City Hamilton WI (Gas) NC (Gas) Rutherford Milwaukee: Statewide Kenosha Summer NJ (Gas, Heavy Duty Diesel) Milwaukee Williamson Statewide Ozaukee Wilson Private garages only TX (Gas) NH (Gas, Light Duty Diesel) Racine Austin: Statewide Sheboygan NM (Gas) Travis Washington Albuquerque: Williamson Waukesha Bernalillo Houston: NV (Gas, Light Duty Diesel) Brazoria Las Vegas: Fort Bend Clark Galveston Reno: Harris Washoe Montgomery NY (Gas, Light & Heavy Duty Diesel) Dallas/Ft. Worth: Statewide Collin OH (Gas, Light Duty Diesel) Dallas Cleveland: Denton Akron Ellis Cuyahoga Johnson Geauga Kaufman Lake Parker Lorain Rockwall Medina Tarrant Portage El Paso: Summit El Paso Warren VA (Gas) OR (Gas, Light Duty Diesel) D. C. Subs. Portland: Alexandria Clackamas Arlington Multnomah Fairfax Washington Falls Church Medford: Loudoun Jackson Manassas (Rogue Valley) Manassas Park PA (Gas) Prince William Northern Region Stafford Philadelphia Region VT (Gas, LIght Duty Diesel) Pittsburgh Region Statewide South Central Region
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