Application for Out of State Extension
Clean Air Car Check Emissions Testing Program

This form is used to verify that your vehicle is at least 300 miles from an Indiana vehicle emissions testing station, and will miss its required Indiana vehicle emissions test. Get PDF version.

*VIN: *Confirm VIN:
*Make: *Model:
*Plate Expiration Date: (mm/dd/yyyy)
*Registered Owner's Name:
*Registered Street Address:
*City: *State: *ZIP:
*Out of State Address (Current Vehicle Location):
*City: *State: *ZIP:
*Expected Date Vehicle will be Returned to Indiana:
*Contact Phone Number:
*Contact Email Address:
Contact Name (If Other than the Registered Owner):

I hereby certify that the above listed vehicle is currently out of state because I am:
(check all that apply)
A Student
On Work Assignment
In Military Service
A Seasonal Resident
Other (Explain):

I submit the following documentation as proof** of my current status: (select one)
Current College Tuition Bill
Documentation on Employer Letterhead
Military Orders
Utility Bill from Out of State Residence (Must be no more than 60 days prior to today's date)
Emissions Test from state where vehicle is located
Out of Area Vehicle Verification
Please upload the document specified above (JPG or PDF files only)

If you are unable to upload documentation, you may exit this online application and submit your paper application by mail.
**Proof should indicate dates of semester, work, military service, etc.
If unable to provide any of the above documentation as proof that the vehicle is currently located out of state, you must also complete and submit an "Out of Area Vehicle Verification” form along with your application for approval.


Standard Processing - $40
Please allow ten business days for processing

Rush Processing - $50
For applications received before 12 p.m. CST, Monday through Saturday, processing will occur the same business day. Applications received after 12 p.m. CST, Monday through Saturday, or any time on Sunday, processing will occur the next business day.

By clicking SUBMIT, I swear, under the penalties of perjury, that to the best of my knowledge the statements I have made herein are accurate, and I agree to bring the vehicle identified on this form in for an emissions test at an Indiana Clean Air Car Check vehicle emissions testing station within fifteen (15) days of being returned to the State of Indiana.
Additional information may be required.