Form EP-009 "Vehicle Emissions Inspection Program - Certified Statement" - Maryland

What Is Form EP-009?

This is a legal form that was released by the Maryland Department of Transportation - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2013;
  • The latest edition provided by the Maryland Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form EP-009 by clicking the link below or browse more documents and templates provided by the Maryland Department of Transportation.

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Download Form EP-009 "Vehicle Emissions Inspection Program - Certified Statement" - Maryland

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Motor Vehicle Administration
EP-009 (02-04)
EP-009 (02-13)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Vehicle Emissions Inspection Program - Certified Statement
Vehicle Emissions Inspection Program – Certified Statement
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Section 1: Vehicle Information
Tag Number
Title Number
Vehicle Identi cation Number
Year
Make
N
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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.
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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
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.
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:
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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),
For more information, please call: 410-768-7000 (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
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov
Motor Vehicle Administration
EP-009 (02-04)
EP-009 (02-13)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Vehicle Emissions Inspection Program - Certified Statement
Vehicle Emissions Inspection Program – Certified Statement
M
V
A
U
s
e
O
l n
: y
C
S
R
D I
D
a
e t
M
i a
e l
d
Section 1: Vehicle Information
Tag Number
Title Number
Vehicle Identi cation Number
Year
Make
N
a
m
e
f o
V
e
h
c i
e l
O
w
n
e
- r
F
r i
t s
M
d i
d
e l
a L
t s
t S
e r
t e
A
d
d
e r
s s
C
y t i
C
o
u
n
y t
S
a t
e t
Z
p i
C
o
d
e
e T
m
p
o
a r
y r
A
d
d
e r
s s
C
y t i
C
o
u
n
y t
S
a t
e t
Z
p i
C
o
d
e
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.
S
g i
a n
u t
e r
e T
e l
p
h
o
n
e
N
u
m
b
r e
D
a
e t
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
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.
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:
C
y t i
C /
o
u
n
y t
S
a t
e t
o
n
f O
c i f
a i
s ’ l
S
g i
a n
u t
e r
B
a
d
g
/ e
D I
#
A
g
e
n
y c
S /
c
h
o
o
/ l
M
l i
a t i
y r
B
a
e s
e T
e l
p
h
o
n
e
#
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),
For more information, please call: 410-768-7000 (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
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) 424-3190
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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