OUT OF AREA EMISSIONS

EXEMPTION APPLICATION FORM

Application must be completed in its entirety in order to be processed, if not, application will be returned

Address Verification
Name: Physical address (no Post Office boxes):

City: County: Apache

Apache
Zip code:

Email address: Telephone number:

Vehicles used to commute into emissions test area

If someone in your household commutes into the emissions test area for employment or is a full-time student at an Arizona college or
university, please check YES box below and complete the next section. Vehicles used to commute into the area for work or school must pass
emissions inspection (ARS 49-542A). Any other vehicles may be exempted.
Do you commute to work YES (see “Used to Commute”)
or school? NO (see “Exempt from Test”)

Vehicle Identification
List all vehicles at this address

Commute/exempt License plate Vehicle ID Number Year/Make Registration Month

number
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test
Used to commute
Exempt from test

Applicant
signature: Date:
Making false statements on this application is a violation of ARS 49-550D and considered an act of perjury.
Exemption (Out of State) – Rev. 10-2017
Instructions for Completing Form: Out-of-Area Emissions Exemption

If you live within either of the mandatory vehicle emissions test areas in Arizona, or if you commute into these areas
on a regular basis for work or school, you must have your vehicle emission tested. These test areas are defined in
statute by township and range. The Motor Vehicle Division (MVD) uses zip codes to identify whether a vehicle may be
subject to testing. However, some zip codes are not fully inside the test area, and contain areas exempt from testing.
This application is used to exempt vehicles from testing that are outside the test area and not used to commute. It is
also used to exempt vehicles registered on Gila River Tribal lands.

Address Verification
Complete this section using the physical address of your residence (not the P.O. Box or mailing address, if different
from the actual location). Use your principle residence telephone number. If you have only a cell phone, note “cell”
after the number. If someone in your household commutes into the vehicle emissions test area for employment or is a
student at an Arizona college or university, check “Yes” and provide the employer or school information, as applicable.
Vehicles used to commute into the area for work or school must pass emissions inspection ARS 49- 542A. If you are
unsure, include those addresses and ADEQ will confirm whether you need to be tested. You may use the “Address
Locator” tool to verify that your residence or workplace is outside of the emissions control area and eligible for an
exemption from testing. Go to: http://gisweb.azdeq.gov/arcgis/veiareas/

Vehicle Identification
If you checked “Yes” (commute to work or school) list in the highlighted area at the top of this section only the
vehicle(s) used to commute into the emission test area. These will not receive an exemption, and must be tested. If
you have no other vehicles you do not need to submit this form. Simply have your vehicles tested at the nearest
emission test station.
If you have vehicles that are not required to be tested (see above), please list the vehicle identification information in
the lower portion of the form on the lines that say “Exempt from test.” These vehicles will receive a special MVD code
so they can be registered without being tested.

Required Documentation
THE FOLLOWING INFORMATION MUST BE PROVIDED TO VERIFY ELIGIBILITY AND PROCESS YOUR APPLICATION,
(EXCEPT FOR VEHICLES DOMICILED ON Gila River TRIBAL LANDS).

• A photocopy of the current Arizona registration for each vehicle listed.

For vehicles domiciled on Gila River Tribal lands, a letter from the Tribal Authority stating the registered owner of the
vehicle is residing on Gila River Tribal lands must be submitted.

Signature
Be sure to sign and date the application. Be aware that providing false statements in this application is a violation of
ARS 49-550(D) and an act of perjury punishable by law.

Submitting
Please mail or email the completed application to the appropriate address below.

Vehicle Emissions Exemptions - Phoenix Vehicle Emissions Exemptions - Tucson

1110 W. Washington Street 400 W. Congress Street. Suite 140
Phoenix, AZ85007 Tucson, AZ 85701
P: 602-771-3950 P: 520-628-5651
F: 602-207-7020 F: 520-628-6139
Email: PHXVEICode52@azdeq.gov Email: TUCVEICode52@azdeq.gov

Publication number: TM-18-09