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Utah State Tax Commission

TC-810
Exemption of Utah Safety and Emission Rev. 10/15
Requirements for Vehicles Not In Utah
Division of Motor Vehicles PO Box 30412, Salt Lake City, UT 84130 Telephone 801-297-7780 or 1-800-368-8824 Get forms online - tax.utah.gov

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:

___________________________________ ____________________________ _________________ _________ ___________

Physical address (not P.O. Box) City County State ZIP code
as a result of _________________________________ and will return to Utah on month _______ day _______ year ______ .
I am currently unable to meet the Utah safety and/or emissions inspection requirements for registration and understand that I must
check one box in each section that applies to my out-of-state location.

Section 2 - Safety Inspection

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.

Section 4 - Owner Information and Signature

Owner's name Telephone number

Owner's UTAH street address City County State ZIP code

UT
Owner or authorized representative's signature Date
X

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.

Cache County Davis County Environmental Health Salt Lake Valley

Bear River Health Department P.O. Box 618 Health Department
85 East 1800 North Farmington , Utah 840 25 788 E. Woodoak Lane #150
North Logan, Utah 84341 801-525-5100 Murray, Utah 84107-6379
435-792-6500 385-468-3837

Utah County Health Department Weber - Morgan

Bureau of Air Quality Program Health Department
3255 North Main Street 477 23rd Street
Spanish Fork, Utah 84660 Ogden, Utah 84401
801-851-7600 801-399-7140
Safety and/or emission inspections must be completed by the jurisdiction where the vehicle is located, before a vehicle can be registered in Utah.
Section 1A - States Section 2A - Jurisdictions As of 2014, the areas listed below must meet EPA standards.
Requiring Safety
Inspection Requiring Emission Inspection The list below does not reflect changes by EPA after this printing.

AZ (Gas, Heavy Duty Diesel) Kane NC (Gas) TX (Gas) Milwaukee

Delaware Phoenix: Kendall Statewide Austin: Ozaukee
Apache Junction Lake NJ (Gas, Heavy Duty Diesel) Travis Racine
District of Columbia
Gold Canyon McHenry Statewide Williamson Sheboygan
Hawaii Maricopa Will Private garages only Houston: Washington
Pinal East St. Louis: NH (Gas, Light Duty Diesel) Brazoria Waukesha
Louisiana Yavapai Madison Statewide Fort Bend
Tucson: Monroe NM (Gas) Galveston
Maine Pima St. Clair Albuquerque: Harris
CA (Gas) IN (Gas) Bernalillo Montgomery
Massachusetts NV (Gas, Light Duty Diesel)
Statewide Chicago Subs: Dallas/Ft. Worth:
Missouri CO (Gas, Light & Heavy Duty Diesel) Lake Las Vegas: Collin
Denver: Porter Clark Dallas
New Hampshire Adams LA (Gas) Reno: Denton
Arapahoe Baton Rouge: Washoe Ellis
New York Boulder Ascension NY (Gas, Light & Heavy Duty Diesel) Johnson
Broomfield East Baton Rouge Statewide Kaufman
North Carolina Denver Ibervile OH (Gas, Light Duty Diesel) Parker
Pennsylvania Douglas Livingston Cleveland: Rockwall
Jefferson West Baton Rouge Akron Tarrant
Rhode Island CT (Gas, Heavy Duty Diesel) ME (Gas, Light & Heavy Duty Diesel) Cuyahoga El Paso:
Statewide Statewide Geauga El Paso
Texas DC (Gas) MA (Gas, Light & Heavy Duty Diesel) Lake UT (Gas, Light & Heavy Duty Diesel)
District-wide Statewide Lorain Salt Lake City:
Utah DE (Gas) MD (Gas, Light & Heavy Duty Diesel Medina Cache
Wilmington: up to 26,000 lbs registered weight) Portage Davis
Vermont
New Castle Baltimore: Summit Salt Lake
Virginia Kent Anne Arundel Warren Utah
Sussex Baltimore OR (Gas, Light Duty Diesel) Weber
West Virginia GA (Gas) Calvert Portland: VA (Gas)
Atlanta: Carroll Clackamas D. C. Subs.
Cherokee Cicel Multnomah Alexandria
Clayton Charles Washington Arlington
Cobb Frederick Medford: Fairfax
Coweta Hartford Jackson Falls Church
Dekalb Howard (Rogue Valley) Loudoun
Douglas D. C. Subs: PA (Gas) Manassas
Fayette Montgomery Northern Region Manassas Park
Forsyth Prince Georges Philadelphia Region Prince William
Fulton Queen Anne's Pittsburgh Region Stafford
Gwinnett Washington South Central Region VT (Gas, LIght Duty Diesel)
Henry RI (Gas, Light & Heavy Duty Diesel) Statewide
Paulding Statewide WA (Gas, Light & Heavy Duty Diesel)
Rockdale TN (Gas, Light Duty Diesel) Seattle:
MO (Gas) Nashville: Bellevue
ID (Gas, Light & Heavy Duty Diesel) St. Louis: Davidson Everette
Boise: Franklin Hamilton Spokane
Ada Jefferson Rutherford Vancouver
IL (Gas) St. Charles Summer Tacoma
Chicago: St. Louis Williamson WI (Gas)
Cook St. Louis City Wilson Milwaukee:
Du Page Kenosha