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