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Senior Exemption Application

Registered Owner Information

The applicant must be 65 years of age and the vehicle must be 10 model years or older to be eligible. Additionally, the vehicle's odometer must be functional and the applicant's name must be the first name listed on the Georgia title or registration.

First Name*

Last Name*

Date of Birth*

Owner Address Line 1*

Owner Address Line 2

City*

State

Zipcode*

County*

Owner Phone Number*

Owner E-mail Address*

Vehicle Identification Information

Year

Make

Model

VIN

Tag Number

Current mileage Do not include commas or decimals.

Is your odometer functional?
The odometer must be functional in order to demonstrate the "under 5,000 miles/year" requirement.

Yes

Proxy Information (If Applicable)

Proxy's First Name

Proxy's Middle Initial

Proxy's Last Name

Proxy's Drivers License Number

Proxy's Phone Number

Attach Files

Copies of the following (scans, camera photos, etc., are acceptable but copies must be completely clear and readable):

Proof of age in the form of a copy of your driver's license, state ID, passport or residence card.
Proof of ownership of the vehicle in the form of a copy of the vehicle's Georgia registration, renewal notice (current or from last year), last year's Georgia tag receipt, or the vehicle's Georgia title. Any of these documents are acceptable as long as the vehicle identification number (VIN) number is included.
You must include copy of the proxy's drivers license or state ID, if applicable.

Attach Proof of Age*

Attach Proof of Vehicle Ownership*

Attach Copy of the Proxy's Drivers License or State ID, if applicable

If you need to add any additional documents to your application after it has been submitted, please visit the Georgia Waivers Help Portal and reference your waiver number. It is not necessary to submit a new application for changes, edits or new documents.

Electronic Signature

As the owner of this vehicle, I certify and represent, under the penalty of law, the information provided herein, and all accompanying documentation supplied with this application, is true, correct and authentic. I understand and acknowledge that submitting false information or fraudulent statements or writings in a matter under the jurisdiction of a state agency is a crime and can result in fines, imprisonment or both (O.C.G.A 16-10-20).

Further, by entering my name in the field below, I certify that I am the person that is the subject of this application, and I fully authorize the Georgia Environmental Protection Division (EPD) and Opus Inspection Technologies, Inc. to accept it as the equivalent signature for any and all purposes, including civil and criminal enforcement actions.

Applicant or Registered Owner Signature (Electronic Signature)

First Name

Last Name

Date

Jun 7, 2026