Dmv Form Vsa 12 PDF Details

The DMV Form VSA-12 is a one-page Virginia state application for an ID card. The form can be used by residents who are age 16 or older and do not have a driver's license. The ID card is valid for five years from the date of issuance, and there is no fee to obtain one. The applicant must provide proof of identity, residency, and citizenship or legal status in the United States. There are several document options that can be used as proof of identity, including a passport, birth certificate, or alien registration card. For residency verification, the applicant can present a utility bill, voter registration card, lease agreement, or pay stub with their current address listed. To prove citizenship or legal status in the U.S., the applicant may use a birth certificate issued by any government agency, passport, naturalization papers, or visa. Instructions on how to complete and submit the DMV Form VSA-12 are included on the form itself. If you're looking to get your hands on some identi

QuestionAnswer
Form NameDmv Form Vsa 12
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesva title form, va affidavit form, vsa 12, va dmv form vsa 12

Form Preview Example

VSA 12 (11/10/2020)

AFFIDAVIT IN LIEU OF TITLE CERTIFICATE

PURPOSE: Use this form to certify unavailability of a current certificate of title for a motor vehicle, trailer, semitrailer or manufactured home due to loss, unlawful detainment or other legitimate circumstance.

INSTRUCTIONS: Complete both sides of this form and other appropriate applications (see reverse for instructions). Submit all forms and applicable fees to DMV at the address above, attention Titling Work Center or present to any DMV Customer Service Center.

CERTIFICATION AND INDEMNIFICATION SECTION and AFFIDAVIT VERIFICATION SECTION MUST BE COMPLETED ON PAGE 2 OR FORM WILL NOT BE PROCESSED.

INSURANCE COMPANIES ONLY: Submit all forms and applicable fees to DMV at the address above, attention Vehicle Branding Work Center.

VEHICLE OWNER INFORMATION

OWNER NAME (print) (if owner is an insurance company enter company name)

CO-OWNER NAME (print)

 

 

 

 

 

IS OWNER AN INSURANCE COMPANY?

YES -- If yes, vehicle MUST have been acquired as part of the claims process. Enter authorized agent/representative

 

name in the space provided below. An additional $25.00 fee applies.

 

NO -- See reverse for additional requirements/fees.

 

 

Vehicle was aquired as a result of the claims process.

 

 

 

 

 

 

OWNER TELEPHONE NUMBER

 

CO-OWNER TELEPHONE NUMBER

OWNER CUSTOMER NUMBER / FEIN

 

 

 

 

 

AUTHORIZED AGENT/REPRESENTATIVE NAME (print) (insurance companies only)

VEHICLE INFORMATION

YEAR

MAKE

MODEL

BODY TYPE

COLOR

VEHICLE IDENTIFICATION NUMBER (VIN)

 

 

 

 

 

 

SUPPORTING INFORMATION - REQUIRED

I/we submit this affidavit in support of my/our application for a certificate of title, salvage certificate or non-repairable certificate for the vehicle described above. The facts regarding my/our acquisition of the vehicle, the reason(s) I/we am/are unable to present a certificate of title for said vehicle, and a description of all efforts made to secure the title are as follows:

VSA 12 (11/10/2020)

Page 2

CERTIFICATION AND INDEMNIFICATION

I/We, the owner(s) listed above, being duly sworn, certify and affirm that all information presented in this form is true and correct, that any documents I/ we have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I/we make this certification and affirmation under penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation.

Further, if the Commissioner of the Virginia DMV issues a certificate of title, salvage certificate or non-repairable certificate pursuant to my/our application and this affidavit, I/we hereby bind myself/ourselves, my/our heirs, assigns and personal representatives to indemnify and save harmless the said Commissioner, and his successors in office, individually and officially, for any loss or damage which may be asserted against him/them or which he/they may sustain as a result thereof.

OWNER OR AUTHORIZED AGENT/REPRESENTATIVE SIGNATURE CO-OWNER SIGNATURE

DATE (mm/dd/yyyy)

AFFIDAVIT VERIFICATION

This affidavit must be verified by DMV Law Enforcement or notarized. One of the sections below must be completed.

DMV LAW ENFORCEMENT VERIFICATION -- As a sworn law enforcement officer with the VA DMV Law Enforcement Division, I verify that I have taken this sworn affidavit, as authorized by VA Code § 46.2-217, and, based on the information presented herein and my investigation, the owner(s) presenting this affidavit has/have established his/her/their rightful ownership of the vehicle identified above.

DMV LE AGENT NAME (print)

DMV LE AGENT SIGNATURE

CASE NUMBER

DATE (mm/dd/yyyy)

NOTARIZATION

State/Commonwealth of ______________________, city or county of _____________________________

subscribed and sworn to before me on this ____________ day of ________________________________

(MONTH)(YEAR)

by___________________________________________________ in the city or county and state aforesaid.

REGISTRATION NUMBER

MY COMMISSION EXPIRES (mm/dd/yyyy)

NOTARY SEAL/STAMP

NOTARY PUBLIC NAME

NOTARY PUBLIC SIGNATURE

INSTRUCTIONS

In order to register a motor vehicle, trailer, semitrailer or manufactured home, or to secure a new title for such a vehicle, the customer must submit a certificate of title. If unable to do so because the title is lost, unlawfully detained by someone who currently holds the title, or if the title is otherwise "not available", the customer may file an affidavit instead.

Insurance Companies

When an insurance company files an affidavit, the affidavit must indicate that the vehicle was acquired as a result of the claims process with the attached supporting documentation showing a claim was paid. Also the affidavit must include a description of the applicant's efforts to obtain the title from the previous owner.

DMV will review the customer's applications and affidavit submitted along with information concerning the circumstances of the case. If DMV determines that the customer is entitled to registration and or titling, it will register the vehicle and issue a new registration card, license plate(s) and a certificate of title, salvage certificate or non-repairable certificate.

Pursuant to Virginia Law, if the current certificate of title for a motor vehicle, trailer, semitrailer or manufactured home is unavailable due to legitimate circumstances, the steps below must be followed:

1.Applicant (owner) must complete and submit form VSA 12, Affidavit in Lieu of Title Certificate.

2.Applicant must also complete and submit with this form one of the following:

a.Application for Certificate of Title and Registration, VSA 17A -- Applicants use this form to apply for a title and/or to register a passenger vehicle, truck, motor home (RV), trailer, motorcycle, or for-hire vehicle.

b.Application for Certificate of Title - Manufactured Home, VSA 17B -- Applicants use this form to apply for a title to a manufactured home.

c.Salvage Certificate Application, VSA 56 -- Applicants use this form to apply for a salvage certificate.

d.Application For Non-Repairable Certificate, VSA 57 -- Applicants use this form to apply for a no-fee non-repairable certificate. Insurance companies use this form to apply for no-fee certificates for non- repairable stolen vehicles or late model vehicles (current year and six preceding years) or any vehicle whose actual value is determined to have been at least $10,000 prior to being damaged.

3.Submit the above forms, applicable fees (visit www.dmvnow.com to obtain fees), title and

sales and use tax, available original documents evidencing ownership and other supporting affidavits.

4.Insurance companies must submit a $25.00 processing fee in addition to the fees associated with the forms listed above.

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Writing part 1 of va dmv form vsa 12

2. Once the previous section is done, you'll want to insert the required specifics in Further if the Commissioner of the, COOWNER SIGNATURE, DATE mmddyyyy, AFFIDAVIT VERIFICATION, This affidavit must be verified by, DMV LAW ENFORCEMENT VERIFICATION, As a sworn law enforcement officer, DMV LE AGENT NAME print, DMV LE AGENT SIGNATURE, CASE NUMBER, DATE mmddyyyy, NOTARIZATION, StateCommonwealth of city or, NOTARY SEALSTAMP, and subscribed and sworn to before me so you can proceed further.

va dmv form vsa 12 completion process explained (portion 2)

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