Vehicle Emissions Inspection Deferral Request

Vehicle Emissions Inspection Deferral

Request Form
Section 1: Vehicle Owner
Name

First NameLast Name
Phone Number
Daytime TelephoneFormat: 000-000-0000.
Email
example@example.com
The Salt Lake County Health Department processes deferral requests only for vehicles registered in Salt Lake County. If your registered address is in one of the following counties, please visit the corresponding link:
- Cache
- Davis
- Utah
- Weber
Salt Lake County Street Address

Street Address

Street Address Line 2

CityState / Province

ZIP Code
City in Salt Lake County
ZIP Code in Salt Lake County

Section 3: Vehicle Location
Providing the Salt Lake County Health Department with your out-of-state address does NOT change your registration address with the Utah Division of Motor Vehicles (DMV).

If you need your registration paperwork, plates, or stickers sent to your out-of-state address rather than your registration address, visit the Utah DMV to change your mailing (situs) address only. The United States Postal Service (USPS) does not forward state mail. For questions about this step, contact the Utah DMV at 801-297-7780.
Out of State Street Address

Street Address

Street Address Line 2

CityState / Province

ZIP Code
Date Vehicle Will Return to Utah (up to 14 months from today)

MonthDayYear

Section 5: Emissions Inspection Form

From jurisdiction where vehicle is located.
Upload document or image showing the vehicle's passing emission inspection.

Cancelof

Section 4: Location Verification
Option 2: Submit a VIN inspection form from the jurisdiction where the vehicle is in operation.

If there is no emissions inspection program where your vehicle is located, you must provide documentation of the vehicle’s location in conjunction with a duly constituted federal, state, county, city, or campus law enforcement or military officer, or a motor vehicle department official.

The officer or official must certify that they verified the VIN of the vehicle identified on this form on the date indicated.
Date VIN Verification Took Place

MonthDayYear
Location Where VIN Verification Took Place

Street Address

Street Address Line 2

CityState / Province

ZIP Code
Name of Verifying Officer

First NameLast Name
Verifying Officer's Phone Number
Daytime TelephoneFormat: 000-000-0000.
Verifying Officer's Badge Number
Verifying Officer's Agency
Upload document or image showing the VIN verification form, including the agency or officer's business card or official stamp.

Cancelof

Vehicle Emissions Inspection Deferral