Form Ep 009 – Fill Out and Use This PDF

EP-009 (11-20)

6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062

Vehicle Emissions Inspection Program – Certified Statement

Section 2: Owner’s Statement of Facts - The vehicle listed in Section 1 is not in compliance with the requirements of the Vehicle Emissions Inspection Program due to the reason stated below. Attach additional information if necessary.

I certify, under penalty of law, that the statements made above are true and correct to the best of my knowledge and belief, under Section 12-109(b) of the Maryland Vehicle Law.

SignatureTelephone NumberDate

Section 3: Repair Facility Statement of Facts

Address

I certify under penalty of law, that the statements made above are true and correct to the best of my knowledge and belief, under Section 12-109(b) of the Maryland Vehicle Law.

Section 4: Out-of-State Verification - If vehicle listed in Section 1 is temporarily located out-of-state, a law enforcement ocial, from the state where the vehicle is located, must verify the vehicle is located in that state and complete this section.

For more information, please call: 410-768-7000 (to speak with a customer service representative).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov

Instructions

Step 1: Owner/Agent must complete Section 1, Vehicle Information.

Step 2: Owner/Agent must complete Section 2 and explain the reason that the vehicle listed in Section 1 has not been emissions inspected as required by Maryland Law.

Step 3: Have Section 3 or 4 completed

Section 3: Vehicle Under Repair/Storage

If the Vehicle has not been emissions inspected due to being under repair or storage at a repair facility, the vehicle owner must complete Sections 1 and 2 and the manager of the repair facility must complete section 3.

Section 4: Vehicles out of Maryland

If the vehicle has not been inspected due to being out of the Maryland emissions test area, the vehicle owner must complete Sections 1 and 2. Have one of the the law enforcement officials listed in Section 4 complete that Section.

Step 4: Please mail the completed form to the address listed below, or the completed form may be faxed to (410) 424-3193

Motor Vehicle Administration

Vehicle Emissions Inspection Program

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

Attn: VEIP Office Supervisor

If additional information is needed, call 410-768-7000.

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