ApplicAtion for

cleAn Air vehicle decAls

STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES

A Public Service Agency

Mail to: DEPaRtMENt oF MotoR VEHiClES

SPECial PRoCESSiNG UNit MS D238
P. o. BoX 932345, SaCRaMENto, Ca 94232-3450

$8 fee reQUired
MAde pAYABle to dMv

Fee applies to all new and replacement decals. Fee does not apply to exempt agencies (except replacement decals) and owner
transfer. Only the registered owner of record may apply. For vehicle qualification, check the California Air Resources Board (ARB)
website at arb.ca.gov. To avoid your application from being delayed or returned unprocessed, check dmv.ca.gov/vr/decal.htm, for
information on completing this form.
VEHiClE liCENSE PlatE No.

VEHiClE iDENtiFiCatioN NUMBER

YEaR

MaKE

MoDEl

section 1 cUrrent reGistered oWner inforMAtion (name printed must match DMV records)

a Change of address (DMV 14) form is also required if the address listed below is a recent change of address, or contains a separate mailing address, currently not on DMV records.
tRUE FUll NaME (LAST, FIRST, MIDDLE) oR BUSiNESS NaME

DRiVER liCENSE oR iD CaRD NUMBER

Co-oWNER tRUE FUll NaME (LAST, FIRST, MIDDLE)

DRiVER liCENSE oR iD CaRD NUMBER

PHYSiCal RESiDENCE oR BUSiNESS aDDRESS (INCLUDE ST., AVE., RD., CT., ETC.)

UNit No. (INDICATE APT., STE., ETC.)

CitY

CoUNtY

MailiNG aDDRESS (IF DIFFERENT FROM PHYSICAL ABOVE)

UNit No. (INDICATE APT., STE., ETC.)

CitY

CoUNtY

StatE

ZiP CoDE

StatE

ZiP CoDE

section 2 cleAn Air vehicle decAls (must check at least one box in all three sections)
the above described vehicle meets California exhaust standards AND federal inherently low-emission vehicle (ilev) standards for
California Clean air Vehicle Decals which permit access to High occupancy Vehicle (HoV) lanes.
NOTE: if this vehicle is a replacement Enhanced at PZEV or tZEV for a previous Enhanced at PZEV or tZEV total loss salvage or
non-repairable vehicle which had Clean air Vehicle Decals, also complete Section 3.
i am requesting: (Check box[es])
original decals
(Never before issued to vehicle)
transfer to new owner
information correction/update
Replacement Decals/iD Card
(Section 3 or 4 also required)

My vehicles exhaust standard is: (Check one)

White decals
ZEV (Zero-Emission Vehicle)
UlEV (Ultra-low Emission Vehicle)
SUlEV (Super Ultra-low Emission Vehicle)
at PZEV (advanced technology Partial ZeroEmission Vehicle)
Green decals
Enhanced at PZEV (Enhanced advanced
technology Partial Zero-Emission Vehicle)
tZEV (transitional Zero-Emission Vehicle)

the motive power is: (Check box[es])

White decals
Electric
Hydrogen fuel cell
liquefied Petroleum Gas (lPG)
Compressed Natural Gas (CNG)
Green decals
Plug-in hybrid
conversions
My vehicle has been converted to
an alternative fuel (aRB Certification
letter required)

section 3 enhAnced At pZev or tZev cleAn Air vehicle replAceMent decAls (total loss/salvage or
non-repairable only)
Effective January 1, 2012, DMV may issue new Clean air Vehicle Decals to owners of qualifying Enhanced at PZEVs or tZEVs purchased
to replace Enhanced at PZEVs or tZEVs that were originally issued Clean air Vehicle Decals prior to the statutory Enhanced at PZEV/
tZEV decal limit, and that have been subsequently declared total loss/salvage or non-repairable. applications under this section must be
filed within six months of the date of the original Enhanced at PZEVs or tZEVs total loss.
NOTE: Regular hybrids with yellow decals Do Not qualify.
a replacement decal is needed because the vehicle was declared a:

total loss/salvage

Non-repairable

Provide previous Enhanced AT PZEV/TZEV vehicle information below.

olD VEHiClE liCENSE PlatE NUMBER

olD VEHiClE iDENtiFiCatioN NUMBER

olD YEaR

olD MaKE

olD MoDEl

olD DECal NUMBER (iF BEiNG REPlaCED)

other:
REG 1000 (REV. 9/2014) WWW

dMv Use onlY

Must complete vehicle information below,
even if not applying for replacement decals:
VEHiClE liCENSE PlatE No.

No. DECalS PiCKED UP CaSHiER liNE DatE StaMP

VEHiClE iDENtiFiCatioN NUMBER

YEaR

iNitialS

MaKE

MoDEl

section 4 replAceMent decAls or id cArd onlY

current decal number:
Replacement iD Card only
Replacement Decals (if any original decals are later located or received, the original decals are canceled and are no
longer valid and must be returned to DMV.)
replacement decals are needed because decals were:
Stolen (a copy of a police report is required.)
lost, Damaged, Destroyed, Faded (a completed/signed statement giving details in Section 5 is required.)
if the vehicle was involved in an accident complete the following:
Front Bumper Damaged/Replaced
Rear Bumper Damaged/Replaced
Both Front/Rear Bumper Damaged/Replaced
(a copy of a repair shop report showing repair to front [if green decals] and/or rear [both white or green decals] of vehicle
must be submitted, if all three [white] or four [green] decals are not surrendered to DMV. if only one bumper was damaged/
replaced, you must surrender the remaining decal[s] from the other bumper.)
Not received from DMV (no fee). allow 30 days from issue date before applying.
Not received from prior owner of vehicle.
other:
disposition of decals (MUst enter number [even if zero] in Both A and B):
NOTE: Decals are issued in sets of three (white) or four (green) and a new decal number will be assigned. all damaged, faded, and
remaining decals must be removed from vehicle and surrendered (including decals in pieces) to DMV with this application (tape to a
separate sheet).
a - total number of decals lost, Damaged, Destroyed, Faded, Not Received, or Stolen:

. if less than three (white) or four (green), (1) explain

B - total number of decals surrendered to DMV with this application:
in Section 5 why the decals are unobtainable, and (2) state that there are no remaining decals on the vehicle.

section 5 stAteMent of fActs (please explain clearly)

section 6 certificAtion (original signature and date required)

the registered owner mailing address is valid, existing, and an accurate mailing address. i consent to receive service of process at this
mailing address pursuant to Vehicle Code Section 1808.21, Code of Civil Procedure Sections 415.20, subdivision (b), 415.30, subdivision
(a), and 416.90. the signature for a company or business must include the printed name of the company/business and an authorized
representatives countersignature on the signature line.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
PRiNtED NaME

DaYtiME tElEPHoNE NUMBER

(
SiGNatURE oF REGiStERED oWNER

DatE

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REG 1000 (REV. 9/2014) WWW