Application for Out of State Compliance or Out of Area ...

Application for Out of State Compliance or Out of Area Exemption

This form may be used when a vehicle is outside the Illinois vehicle emissions testing area Please type or print legibly and complete all fields on the application

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Vehicle Information

Illinois License Plate Number

Vehicle Identification Number (VIN)

Model Year

Vehicle Make

Vehicle Owner Information

Registered Owner 1

Street Address

City

Daytime Telephone Number

(

)

Email Address

State

Zip Code

Registered Owner 2

Street Address

City

Daytime Telephone Number

(

)

Email Address

State

Zip Code

How should we contact you:

Phone

(Please select only one method)

Email

U.S. Mail

Location of Vehicle: The undersigned hereby certifies that the vehicle identified above is located at the following address:

Address

City

County

State

Zip Code

Country

Please read carefully and select correct application type

(Only select one)

Out of State Compliance When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is required. Proof of a passing emissions test from the state where the vehicle is located must be submitted with this application. See application instructions for details.

Out of Area Exemption When a vehicle is located and primarily used outside of the Illinois vehicle emissions testing area and is located in a state/county where vehicle emissions testing is not required. Proof of where the vehicle is located must be submitted with this application. See application instructions for details.

(See page 2 of application for further instructions and acceptable forms of proof)

The undersigned hereby certifies that the statements contained herein are true and correct and further certifies that the vehicle identified above is located at the address stated herein and primarily operated outside of the vehicle emissions testing area and in the area identified above. By affixing his/her signature hereto the undersigned further certifies that he/she is authorized to execute this form.

The Illinois EPA is authorized to require, and you shall disclose, the information requested on this form pursuant to 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276. This information shall be provided using this form or by alternative means at your discretion. Failure to disclose the requisite information or comply with 625 ILCS 5/13C and/or 35 Ill. Adm. Code Part 276 may result in this application being denied and/or penalties being imposed as provided for by applicable law. Any person who knowingly makes false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Registered Owner's Signature

Date

IL 532-3040 VIM 171 Rev. 09/2019

Application Instructions

Out of State Compliance - When a vehicle is located and primarily used outside of the Illinois vehicle emissions

testing area and is located in a state/county where vehicle emissions testing is required.

This form may be used to provide proof of compliance with the Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C) for a vehicle that has been inspected and is in compliance with the vehicle emissions testing standards applicable in the state or county where the vehicle is currently located and operated. Out of state compliance is granted for a maximum of two (2) years.

Along with this completed application, you must include proof that the vehicle has passed an emissions test or received a waiver or exemption, or otherwise complied with the emissions testing requirement of the state or county where the vehicle is located and operated. A vehicle inspection report or other documentation dated more than four (4) months prior to your Test by Date will NOT be accepted. Failure to submit the correct documentation may result in denial of your application.

For a list of states where vehicle emissions testing is required visit

Out of Area Exemption - When a vehicle is located and primarily used outside of the Illinois vehicle emissions

testing area and is located in a state/county where vehicle emissions testing is not required.

This form may be used to apply for an out of area exemption from the vehicle emissions testing requirement in accordance with the Vehicle Emissions Inspection Law of 2005 (625 ILCS 5/13C-15(b)(9)) and 35 Ill. Adm. Code Section 276.405. This form is used to verify the current location of the vehicle outside the Illinois vehicle emissions testing area and where emissions testing is not required. Out of area exemptions are granted for a maximum of one (1) year.

Along with this completed application, you must include proof of where the vehicle is currently located. Documents submitted must display your preprinted name and address. Documentation submitted must be dated within three (3) months of submission. Documentation dated more than three (3) months prior to submittal of your application will NOT be accepted. Failure to submit the correct documentation may result in denial of your application.

Acceptable forms of proof include: Property Tax Bill Utility Bill Military Orders Tuition Bill Lease Signed by Both the Tenant and Landlord Vehicle Storage Receipt Bank Statement Credit Card Bill Medical Bill Driver's License National Student Clearinghouse Certificate Letter from Employer on Company Letterhead

Information submitted on this form must be legible. Please include the license plate number and your telephone number on all documentation.

Submit this form and all documents by one (1) of the following methods:

Web:



Email to: Waivers@

Fax to: 312.327.7640

Mail to: Applus Technologies, Inc., PO Box 3266, Glen Ellyn, IL 60137-9998

If you have any questions about acceptable documentation, please call the Illinois Air Team at: 844.258.9071

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