The C52 C form, commonly referred to as the Emissions Exemption Form, plays a pivotal role in the lives of vehicle owners residing in specific areas affected by emissions control measures. Designed for those whose vehicles are registered outside of emissions control areas but still fall within certain zip codes that require emissions testing or for residents on Gila River Tribal lands, this form offers a path to exemption. To be eligible, applicants must demonstrate that the concerned vehicles are not used for commutes into emissions control areas for work or school-related purposes. The form mandates the provision of detailed personal and vehicle information, including physical address, employment address, and a listing of both the vehicle(s) used to commute and those being exempted from emissions testing. Critical to the application process is the submission of supporting documents like current vehicle registration forms, utility bills, property tax notices, or, for residents on Gila River Tribal lands, a letter from the Tribal Authority. Completing and signing the form not only requires a meticulous attention to detail but also a declaration of the truthfulness of the provided information, under penalty of law for falsification. This form underscores the balance between regulatory compliance and individual responsibility, ensuring that emissions standards are met while recognizing exceptions for those who qualify.
| Question | Answer |
|---|---|
| Form Name | Form C52 C |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | code52 adeq exempt form |
Emissions Exemption Form (Code 52)
ADEQ Air Quality Vehicle Emissions
Code 52 Exemption is issued for vehicles registered outside of the emissions control area, but within zip codes which include emissions testing or on Gila River Tribal lands. By signing this form, the applicant affirms that the vehicle(s) listed are not operated within the emissions control area for employment or school. Please provide the following information (print or type), sign, and return to any Motor Vehicle Division office, or mail to ADEQ at the address below.
Name:____________________________________________________________________________________________
Physical Address:___________________________________________________________________________________
County:_______________________________ City and Zip Code:_______________________________________
Legal Description of Residence: Section, Township, and Range can be found on the property tax evaluation notice and is required for identifying exemption eligibility, except for vehicles domiciled on Gila River Tribal lands.
Section:__________________ Township:______________________ Range:____________________
Residence Telephone:_______________________________________________________________________________________
Employer:________________________________________________________________________________________________
Employment Address:_______________________________________________________________________________________
List vehicle(s) used to commute to place of employment or school:
Plate No.
Vehicle ID No.
Year/Make
Registration Month
List vehicle(s) exempt from emissions testing:
The following information must be provided to verify eligibility and process your application, except for vehicles domiciled on Gila River Tribal lands.
1.A photocopy of the current registration for each vehicle listed.
2.A photocopy of a current utility bill in the name of the applicant, identifying the physical address of residence.
3.A photocopy of property owner’s tax evaluation notice, listing the residence township, range and section. If you do not own the property, a photocopy of the lease/rental agreement will be required.
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.
Please sign below:
I hereby certify that the information supplied on this application is true, and that the exempt vehicle(s) listed are not used to commute into the vehicle emissions control area for work or school. (A.R.S. §
Applicant’s Signature________________________________________________ |
Date:____________________________ |
|
ORIGINAL (WHITE) – MVD |
COPY (YELLOW) – ADEQ (Not required when original mailed to ADEQ) |
|
VEHICLE EMISSIONS – PHOENIX |
VEHICLE EMISSIONS - TUCSON |
|
600 N 40TH STREET, PHOENIX, AZ 85008 |
4040 N. 29TH STREET, TUCSON, AZ 85711 |
|
FAX: |
FAX: |
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