Final Approval Application for the
Alternative Fuel Grant Program

Please attach the following scanned documents (as images in the .jpg, .png or .pdf formats).

Business Registration
Business License
LPG Dealer License (R710-6)
Installer LPG Certification (R710-6)
EPA Certification of Conformity of the 40 CFR Part 85 and 86
Invoice*
W-9
Vehicle Inspection or Functional Statement (include VIN)
Vehicle Registration

* The final invoice must include a receipt signed by the vehicle owner that includes the itemized costs and demonstrates that the grant has been passed on to the vehicle owner.

I certify that the conversion does not tamper with, circumvent, or otherwise affect the vehicle’s on-board diagnostic system, in accordance with Utah Code 19-1-406(2).