Wisconsin Department of Transportation
Research and Information Unit
P.O. Box 8070
Madison, WI 53708-8070
TEMPORARY EXEMPTION APPLICATION
Exemption From Vehicle Emission Inspection
MV2472 5/2015 s.110.20(9) Wis. Stats.
INSTRUCTIONS
1. Complete this application. Please be sure to indicate the date your vehicle will again be operated
in Southeastern Wisconsin.
2. Mail this application, your renewal notice and registration fee to the address above.
Upon receiving your application and fee, we will send you the new Certicate of Registration and renewal sticker. Shortly thereafter you
will receive a Temporary Exemption Approval letter, which will contain instructions for completing the testing requirements. Take that
letter with you when you have your vehicle tested.
If you have questions, please call 608-266-1466.
Date Vehicle is Expected to be Operated Again in Southeastern WI
License Plate Number
1 2 3 4 5 6 7 8
Registration Expiration
Vehicle Year Vehicle Make Vehicle Identication Number (standard VIN has 17 characters)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Owner Name Last First Middle Initial Area Code - Telephone Number
Street Address City State Zip Code
Street Address City State Zip Code
(Date)
(Owner Signature)
X
I certify that to the best of my knowledge the information and statements on this application are true and correct.
I request temporary exemption from vehicle emission inspection because:
My vehicle is temporarily inoperable. Please explain why:
My vehicle is temporarily being operated in a location where emission inspections are not available.
Please give location:
Other, please explain:
