Form Tc-810mc - Exemption Of Utah Safety And Emission Requirements For Apportioned Vehicles Not In Utah

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Utah State Tax Commission
TC-810MC
Exemption of Utah Safety and Emission
Rev. 3/13
Requirements for Apportioned Vehicles Not In Utah
Get forms online - tax.utah.gov
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824
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
Fuel
Utah plate number
Unit number
Vehicle Identification Number (VIN)
Fleet number
I understand that, under Utah Code and when located in Utah, the above-described vehicle would be required to pass a safety and/or
emissions inspection prior to registration in the State of Utah. I hereby certify that the above-described vehicle is part of a fleet licensed
under the International Registration Plan (IRP) and is now located out-of-state at:
___________________________________ ____________________________ _________________
_________
___________
Physical address (not P.O. Box)
City
County
State
ZIP code
I further certify that the vehicle is in compliance with local safety and/or emissions inspection laws if located in a state shown on the
reverse side of this form.
Section 2 - Owner Information and Signature
Owner's name
Telephone number
Owner or authorized representative's signature
Date
X
IMPORTANT INSTRUCTIONS: 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. At the time of vehicle
registration, return this completed form with the renewal documents and all required fees to the Motor Carrier Services
(do not send cash in the mail). If you have questions about this form, please call (801) 297-6800 or 1-800-251-9555.
Salt Lake Valley
Utah County Health Department
Davis County
Environmental Health
Weber - Morgan
Health Department
Bureau of Air Quality Program
P.O. Box 618
Health Department
788 E. Woodoak Lane #150
3255 North Main Street
Farmington
, Utah 840
25
477 23rd Street
Murray, Utah 84107-6379
Spanish Fork, Utah 84660
801-525-5100
Ogden, Utah 84401
385-468-3837
801-851-7600
801-399-7140

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