Pennsylvania Form Mv 9 – Fill Out and Use This PDF

INSTRUCTIONS: This self-certification form is to be used with anApplication for Certificate of Title for every model year 2008 or newer passenger vehicle or light duty truck with a gross vehicle weight rating of 8,500 pounds or less in situations where:

1.The vehicle meets the certification requirements of the Pennsylvania Clean Vehicles Program; however, a Manufacturer’s CertificateofOriginisnot available. Complete Section C,inadditiontoSectionsA,B,andE. NOTE:Individualsshouldlist theirPADriver’sLicense(PADL)orPhotoID#inthespaceprovided. BusinessesshouldlisttheirBusinessID#(Bus. ID)where indicated(i.e. E.I.N.).

2.ThevehicleisexemptfromthecertificationrequirementsofthePennsylvaniaCleanVehiclesProgram. Complete Section D, inadditiontoSectionsA,BandE.

A VEHICLE INFORMATION
	Vehicle Identification Number			Year			Make
	Gross Vehicle Weight Rating			CurrentOdometerreading
				(Excludetenths)	___ ___ ___ , ___ ___ ___
B VEHICLE OWNER INFORMATION
	Last Name (or Full Business Name)	First Name		Middle Name	PADL/PhotoID#or			DateofBirth
					Bus. ID#
	Co-owner Last Name	First Name		Middle Name	PADL/PhotoID#			DateofBirth
	Current StreetAddress		City			State		Zip Code

CCOMPLIANCE CERTIFICATION

❒Icertifythatthisvehicleisamodelyear2008ornewer,withagrossvehicleweightratingof8,500poundsorless,withless than 7,500 miles on the odometer and complies with U.S.E.P.A. and California emission control regulations. There is evidenceofthisbyamanufacturer’sinstalledlabelunderthehoodofthevehicle.

DEXEMPTION CERTIFICATION

I certify that this vehicle is exempt from Pennsylvania Clean Vehicles Program certification compliance because:

❒This is an emergency vehicle.

❒This vehicle is being transferred for use exclusively off-highway.

❒This vehicle was granted a national security or testing exemption under Section 203(b)(1) of the CleanAirAct (42 U.S.C.A. Section 7522(b)(1)).

❒This vehicle was acquired for the purpose of replacing a vehicle which was damaged, or became inoperative, beyond reasonablerepairorwasstolenwhileoutoftheCommonwealthofPennsylvaniaandthereplacement vehiclewasacquired out of this Commonwealth at the time the previously owned vehicle was damaged, became inoperative or was stolen. The vehicle identification number of the vehicle that was replaced was _____________________________.

❒This vehicle was transferred by inheritance or court decree.

❒This vehicle was titled and registered while the owner or lessee was aresident of another state and the owner or lessee is moving to Pennsylvania.

❒This vehicle has more than 7,500 miles at time of completing the application for Pennsylvania Certificate of Title.

ESIGNATURE

The signature below hereby certifies under penalty of law that the information contained herein is true and correct. WARNING: Falsification to authorities is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 PAC.S. Section 4904 (b))

____________________________________________________________	_______________________________
Applicant Signature	Date
____________________________________________________________	_______________________________
Co-OwnerSignature	Date

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