REG 139, Vehicle Emission System Statement (Smog)

1 MAKE Vehicle IDENTIFICATION NUMBER LICENSE PLATE NUMBERVEHICLE Emission System Statement ( smog )(California Vehicle Code Section )The seller is required to furnish the purchaser this Statement if a transfer application is submitted to the department within 90 days of the submission of a valid smog certifi cation that was not obtained specifi cally for the TO THE BUYERA valid certifi cate of compliance was submitted to the Department of Motor Vehicles with an application for the renewal of registration of this Vehicle . If an application for transfer is submitted to the department within the 90-day validity period of the smog certifi cation, no new smog certifi cation will be required. However, at present, you may be purchasing a Vehicle that may not be in compliance with specifi ed Emission signing this Statement , you acknowledge that the seller is not required to provide you with an additional smog certifi cate prior to the completion of this may have this Vehicle tested at a licensed smog check station prior to completion of this transaction to verify compliance.

2 If the Vehicle passes the test, you shall be responsible for the costs of the test. If the Vehicle fails the test, the seller is obligated to reimburse you the cost of having the Vehicle tested and, without expense to you, must have the Vehicle repaired to comply with specifi ed Emission standards prior to completion of this NAME AND SIGNATURE OF SELLER (TRANSFEROR ) DATEPRINTED NAME AND SIGNATURE OF BUYER (TRANSFEREE ) DATEI have not modifi ed, nor do I have knowledge of anyone else modifying the Emission System of this Vehicle in any way that would make the Emission System fail to pass the tests for smog certifi cation required by Section 44015 of the California Health and Safety Code. I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and form is for your records. Do not submit it to the Department of Motor VehiclesREG 139 (REV. 5/2007) WWWPRINTED NAME AND SIGNATURE OF SELLER (TRANSFEROR ) DATEA Public Service AgencyDISTRIBUTION: ORIGINAL BUYER DUPLICATE SELLER