Vehicle Inspection Certificate for Utah Department of Public Safety

VEHICLE INSPECTION CERTIFICATE

STATE OF UTAH DEPARTMENT OF PUBLIC SAFETY / DIVISION OF MOTOR VEHICLES

I. VEHICLE IDENTIFICATION

To be completed by the vehicle owner or authorized inspector.

Vehicle Identification Number (VIN): [__________________________________________________] Make: [____________________] Model: [____________________] Year: [__________] Body Style: [____________________] Color: [____________________] Odometer Reading: [____________________] License Plate Number: [____________________]

II. INSPECTION CATEGORY

Please check the applicable box(es):

[ ] Safety Inspection (Required for specific vehicle types per Utah Code) [ ] Emissions Inspection (Required by county of registration) [ ] VIN Verification (For out-of-state/salvage titles) [ ] Other: [__________________________________________________]

III. INSPECTION CRITERIA

The undersigned inspector has evaluated the following systems in accordance with Utah Administrative Code.

IV. INSPECTOR CERTIFICATION

I, the undersigned licensed inspector, hereby certify that I have conducted a physical examination of the vehicle described above on this date. The findings documented herein represent the condition of the vehicle at the time of inspection.

Inspector Name (Print): [__________________________________________________] Inspector License/ID Number: [__________________________________________________] Inspection Facility Name: [__________________________________________________] Facility Address: [__________________________________________________] Date of Inspection: [_____/_____/__________]

Inspector Signature: ________________________________________

V. OWNER/OPERATOR ACKNOWLEDGMENT

I, the undersigned owner or authorized operator, certify that the information provided is accurate and that I am aware of the inspection results. I understand that this form does not guarantee the long-term mechanical reliability of the vehicle.

Owner/Operator Name (Print): [__________________________________________________] Owner/Operator Address: [__________________________________________________]

Owner/Operator Signature: ________________________________________ Date: [_____/_____/__________]

Disclaimer: This document is intended for record-keeping purposes in accordance with Utah state vehicle compliance standards. Ensure all specific county emissions requirements are verified against current DMV regulations.