REG 5103 (NEW 4/2014) WWW
STATE OF CALIFORNIA
DEPARTMENT OF MOTOR VEHICLES
®
A Public Service Agency
ApplicAtion for temporAry SmoG exemption
for A Vehicle locAted out-of-StAte
(h&Sc §44011, cVc §§20, 1653, 8800)
Your vehicle may qualify for temporary exemption from biennial smog requirements if it is temporarily located out of
state. You must provide the following information in order to determine eligibility for the exemption.
Section 1 — Vehicle informAtion
VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODEL VEHICLE LICENSE NUMBER
As of the vehicle has been located outside of California and is currently physically located/garaged at:
DATE
STREET ADDRESS CITY STAT E ZIP CODE
The vehicle is temporarily located out of state because
The vehicle cannot or is not required to be registered in the state of because
The above vehicle will continuously be located outside California until . The required smog certication
DATE
will be obtained and submitted to DMV upon the vehicle’s return to California.
Contact information of person operating the vehicle out of state:
TRUE FULL NAME DAYTIME TELEPHONE NUMBER
( )
Section 2 — certificAtion
the informAtion you Are proVidinG iS Subject to VerificAtion by dmV And your reGiStrAtion mAy be
Subject to cAncellAtion.
EXECUTED ON (DATE) AT ( CITY) STAT E
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
PRINT TRUE FULL NAME SIGNATURE
x
DAYTIME TELEPHONE NUMBER
( )
MAILING ADDRESS CITY STAT E ZIP CODE
note: Vehicles located in the following cities are ineligible for the exemption.
Nevada Mexico
Carson City
Centerville
Crystal Bay
Gardnerville
Genoa
Glenbrook
Incline Village
Minden
Reno
Sparks
Stateline
Stewart
Washoe City
Verdi
Zephyr Cove
Tecate
Tijuana
Tijuana Baja CA
