Form TD-420-539 "California Emissions Compliance/Exemption Certification" - Washington

What Is Form TD-420-539?

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

Form Details:

  • Released on April 1, 2011;
  • The latest edition provided by the Washington State Department of Licensing;
  • 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 printable version of Form TD-420-539 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form TD-420-539 "California Emissions Compliance/Exemption Certification" - Washington

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California Emissions Compliance/Exemption Certification
You can use this form to title and/or register a vehicle when you do not have the Manufacturer’s Certificate of Origin.
Model year 2009 and newer passenger cars, medium duty passenger vehicles, and light-duty trucks must have been
manufactured to meet California emissions standards to be registered in Washington. After completing and signing this
form, turn it in to any vehicle licensing office with a Title/Registration Application.
• This form is only required for model year 2009 and newer passenger cars, medium duty passenger vehicles with a
gross vehicle weight rating less than 10,000 pounds, and light-duty trucks with a gross vehicle weight rating 8,500
pounds or less in the absence of a Manufacturer’s Certificate of Origin.
• Write the vehicle year, make, model, and vehicle identification number (VIN) in the space provided for the vehicle you
want to register.
• Check the box(es) listed below that describe the vehicle you want to register.
• Read the certification statement, then print and sign your name.
Under hood emission label
An emission label can be found permanently affixed under the hood of every vehicle.
This label will have the following, or similar, wording indicating the vehicle conforms
or is certified to California emission standards:
• For a California-only vehicle: This vehicle conforms to U.S. EPA and California
regulations applicable to 2009 model year new motor vehicles introduced into
commerce only for sale in California.
• For a 50-state vehicle: This vehicle conforms to U.S. EPA and California
regulations applicable to 2009 model year new motor vehicles.
• For a federal vehicle certified for sale in California: This vehicle conforms to
U.S. EPA regulations applicable to 2009 model year new motor vehicles, and is
certified for sale in California.
While the above examples refer to “2009,” the year shown on the label of your vehicle will match your vehicle’s model year.
Vehicle year
Make
Model
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
VIN
Emissions compliance certification
I certify this vehicle complies with California emissions standards. There is evidence of compliance on the vehicle’s
under-hood emission label. (WAC 173-423-050)
Emissions exemption certification
Military Tactical Vehicle
Vehicle sold for registration out of state (vehicle will not be registered in Washington)
Rental vehicle – Final destination outside of Washington
Emergency vehicle exempted by Department of Ecology
Gross Vehicle Weight Rating over 10,000 pounds (passenger vehicles only)
Gross Vehicle Weight Rating over 8,500 pounds (truck-type vehicles only)
Vehicle has more than 12 seats (including driver)
Vehicle has more than 9 seats behind driver
I purchased this vehicle before becoming a Washington resident
I acquired this vehicle by inheritance
I acquired this vehicle by divorce, dissolution, or legal separation
Vehicle was registered in another state/jurisdiction and the mileage on the odometer was over 7,500 miles at the time of
the private sale or at the time of acquisition by a vehicle dealer
I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
_______________________________________________________________________________
PRINT applicant name
X
_______________________________________________________
_______________________________________________________________________________
Date and place
Signature
Washington State law makes it clear that it is a felony to knowingly make a false statement of fact. The penalty, upon conviction, shall be
a fine of not more than $5,000 or by imprisonment for not more than ten years, or both the fine and imprisonment. (RCW 46.12.210)
We are committed to providing equal access to our services.
If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.
TD-420-539 (R/4/11)
California Emissions Compliance/Exemption Certification
You can use this form to title and/or register a vehicle when you do not have the Manufacturer’s Certificate of Origin.
Model year 2009 and newer passenger cars, medium duty passenger vehicles, and light-duty trucks must have been
manufactured to meet California emissions standards to be registered in Washington. After completing and signing this
form, turn it in to any vehicle licensing office with a Title/Registration Application.
• This form is only required for model year 2009 and newer passenger cars, medium duty passenger vehicles with a
gross vehicle weight rating less than 10,000 pounds, and light-duty trucks with a gross vehicle weight rating 8,500
pounds or less in the absence of a Manufacturer’s Certificate of Origin.
• Write the vehicle year, make, model, and vehicle identification number (VIN) in the space provided for the vehicle you
want to register.
• Check the box(es) listed below that describe the vehicle you want to register.
• Read the certification statement, then print and sign your name.
Under hood emission label
An emission label can be found permanently affixed under the hood of every vehicle.
This label will have the following, or similar, wording indicating the vehicle conforms
or is certified to California emission standards:
• For a California-only vehicle: This vehicle conforms to U.S. EPA and California
regulations applicable to 2009 model year new motor vehicles introduced into
commerce only for sale in California.
• For a 50-state vehicle: This vehicle conforms to U.S. EPA and California
regulations applicable to 2009 model year new motor vehicles.
• For a federal vehicle certified for sale in California: This vehicle conforms to
U.S. EPA regulations applicable to 2009 model year new motor vehicles, and is
certified for sale in California.
While the above examples refer to “2009,” the year shown on the label of your vehicle will match your vehicle’s model year.
Vehicle year
Make
Model
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
VIN
Emissions compliance certification
I certify this vehicle complies with California emissions standards. There is evidence of compliance on the vehicle’s
under-hood emission label. (WAC 173-423-050)
Emissions exemption certification
Military Tactical Vehicle
Vehicle sold for registration out of state (vehicle will not be registered in Washington)
Rental vehicle – Final destination outside of Washington
Emergency vehicle exempted by Department of Ecology
Gross Vehicle Weight Rating over 10,000 pounds (passenger vehicles only)
Gross Vehicle Weight Rating over 8,500 pounds (truck-type vehicles only)
Vehicle has more than 12 seats (including driver)
Vehicle has more than 9 seats behind driver
I purchased this vehicle before becoming a Washington resident
I acquired this vehicle by inheritance
I acquired this vehicle by divorce, dissolution, or legal separation
Vehicle was registered in another state/jurisdiction and the mileage on the odometer was over 7,500 miles at the time of
the private sale or at the time of acquisition by a vehicle dealer
I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
_______________________________________________________________________________
PRINT applicant name
X
_______________________________________________________
_______________________________________________________________________________
Date and place
Signature
Washington State law makes it clear that it is a felony to knowingly make a false statement of fact. The penalty, upon conviction, shall be
a fine of not more than $5,000 or by imprisonment for not more than ten years, or both the fine and imprisonment. (RCW 46.12.210)
We are committed to providing equal access to our services.
If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.
TD-420-539 (R/4/11)