Form TD-420-810 "Collectible Vehicle Certification for Emission Test Exemption" - Washington

What Is Form TD-420-810?

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 September 1, 2017;
  • 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 fillable version of Form TD-420-810 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-420-810 "Collectible Vehicle Certification for Emission Test Exemption" - Washington

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Click here to START or CLEAR, then hit the TAB button
Collectible Vehicle Certification
for Emission Test Exemption
Use this form to certify that your vehicle meets the definition of a collectible vehicle and is exempt from emission test
requirements. A collectible vehicle is defined as being unique or is of rare design, has limited production, and is an object
of curiosity.
Registered owner
PRINT or TYPE Name
Address
City
State
Zip Code
(Area code) Telephone number
Email address
Vehicle identification number (VIN), if applicable
Model year
Make
Model
Certification
If you answer “no” to any of the following questions, your vehicle does not qualify as collectible and must meet emission
test requirements.
1. Is this vehicle used primarily for car club activities, exhibitions, parades, functions of public interest,
a private collection, or used infrequently for other purposes?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Do you have collectible vehicle or classic automobile insurance coverage that restricts the
vehicle mileage, use, or both? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3. Do you have another vehicle for personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place (city or county) signed
Registered owner signature
The Department of Ecology may contact you for additional documented proof of collectible or classic vehicle
insurance, use of the collectible vehicle, or information regarding your other personal use vehicle.
If your vehicle no longer meets the definition of a collectible vehicle you must obtain an emission test and notify
the Department of Licensing.
RCW 46.04.123
TD-420-810 (R/9/17)WA
Click here to START or CLEAR, then hit the TAB button
Collectible Vehicle Certification
for Emission Test Exemption
Use this form to certify that your vehicle meets the definition of a collectible vehicle and is exempt from emission test
requirements. A collectible vehicle is defined as being unique or is of rare design, has limited production, and is an object
of curiosity.
Registered owner
PRINT or TYPE Name
Address
City
State
Zip Code
(Area code) Telephone number
Email address
Vehicle identification number (VIN), if applicable
Model year
Make
Model
Certification
If you answer “no” to any of the following questions, your vehicle does not qualify as collectible and must meet emission
test requirements.
1. Is this vehicle used primarily for car club activities, exhibitions, parades, functions of public interest,
a private collection, or used infrequently for other purposes?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Do you have collectible vehicle or classic automobile insurance coverage that restricts the
vehicle mileage, use, or both? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3. Do you have another vehicle for personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place (city or county) signed
Registered owner signature
The Department of Ecology may contact you for additional documented proof of collectible or classic vehicle
insurance, use of the collectible vehicle, or information regarding your other personal use vehicle.
If your vehicle no longer meets the definition of a collectible vehicle you must obtain an emission test and notify
the Department of Licensing.
RCW 46.04.123
TD-420-810 (R/9/17)WA