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Reg 5103 PDF Details

Have you ever wondered what the Reg 5103 Form is? If you don't know, it's okay. This blog post will inform you about this form and its purpose. The Reg 5103 Form is a Reconciliation of Tax Exempt Income statement. It is used to report all tax exempt income received by an organization during a fiscal year. This form must be filed with the organization's annual return (Form 990). In short, the Reg 5103 Form is a statement that reports an organization's tax exempt income for a fiscal year. It must be filed with the organization's annual return (Form 990).

If you'd like to look at various specific details regarding the file you intend to work with, here is the information you might like to study prior to filling in the reg 5103.

Question	Answer
Form Name	Reg 5103
Form Length	1 pages
Fillable?	Yes
Fillable fields	24
Avg. time to fill out	5 min 7 sec
Other names	california dmv reg 5103, form 5103 form, dmv application for temporary smog exemption, california 5103

12

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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	statE	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 certification
		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)

statE

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

mailiNG addREss

siGNatuRE	daYtimE tElEphoNE NumbER
x	(	)
citY		statE	Zip codE

note: Vehicles located in the following cities are ineligible for the exemption.

Nevada		Mexico
carson city	Reno	tecate
centerville	sparks	tijuana
crystal bay	stateline	tijuana baja ca
Gardnerville	stewart
Genoa	Washoe city
Glenbrook	Verdi
incline Village	Zephyr cove
minden

REG 5103 (NEW 5/2014) WWW

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Provide the expected data in the section at, City statE, daYtimE, tElEphoNE, NumbER siGNatuRE, mailiNG, addREss citY, statE, Zip, codE Mexico, te, cate, tijuana, tijuana, baja, ca Nevada, and REG, NEW, WWW

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