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
Vehicle Emissions Inspection Program – Certied Statement
EP-009 (11
-20)
For more information, please call: 1-800-638-8347 (touch tone calls only), 1-800-950-1MVA (1682) (to speak with a customer service representative),
From Out-of-State: 1-301-729-4550, TTY for the hearing impai red: 1-800-492-4575. Visit our website at: www.marylandmva.com
Vehicle Emissions Inspection Program - Certified Statement
EP-009 (02-04)
de l i aM e t aDDI RSC : y l nO esU AVM
Tag Number Title Number Vehicle Identication Number Year Make
tsr iF - ren wO elc iheV fo emaN t saLe l dd iM
e d oC p i Ze t a tSy t n u oCy t iCsserd d A teer tS
e d oC p i Ze t a tSy t n u oCy t iC
s s e r d d A y r a r o pme T
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.
e t aDr e bmu N e n o h p e l e T
e r u t ang i S
Section 3: Repair Facility Statement of Facts
The vehicle listed in Section 1 has been under repair/storage at our facility from to
Repair Facility Name Phone Number
Addr
ess
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.
Repair Facility Manager Date
Section 4: Out-of-State Verification - If vehicle listed in Section 1 is temporarily located out-of-state, a law enforcement ocial,
from the state where the vehicle is located, must verify the vehicle is located in that state and complete this section.
one of the following: Local/State/Federal Law Enforcement Officer School Security Officer Military Law Enforcement Officer
I certify that the vehicle described in Section 1 is located in this state and was observed in:
noe t a tSytnuoC/yt iC
# D I / egdaB
erutang iS s la i c i f fO
# enohpe l e T
es aB y r a t i l iM/ l oohcS / ycnegA
Section 1: Vehicle Information
6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062
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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.