Dmv Form Vsa 17A PDF Details

Navigating through the process of securing a title and registration for various types of vehicles such as passenger cars, motorcycles, trucks, motor homes (RVs), or trailers is facilitated by the VSA 17A form, a crucial document issued by the Department of Motor Vehicles (DMV). This form, officially titled "APPLICATION FOR CERTIFICATE OF TITLE AND REGISTRATION," is designed for use by individuals or businesses aiming to establish legal ownership and obtain the necessary registration to operate their vehicles on public roads. Updated as of 07/01/2021, the form is comprehensive, catering to both title and registration requests, including an electronic title option for those who prefer a digital record. Essential information such as owner details, vehicle specifics, and lien data must be accurately filled out and submitted to a DMV customer service center, where additional proof might be requested to verify the provided details. Through sections dedicated to ownership type, whether individual or joint, and other particulars like vehicle identification number (VIN), odometer readings, and insurance certification, the form meticulously gathers all requisite information. It even includes provisions for addressing personal property tax relief eligibility, emphasizing the form's role in ensuring compliance with state laws and facilitating a smoother transaction between the vehicle owner and the DMV.

QuestionAnswer
Form NameDmv Form Vsa 17A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesva dmv title, vsa 17a, virginia dmv online services title, dmv application certificate title

Form Preview Example

APPLICATION FOR

CERTIFICATE OF TITLE AND REGISTRATION

VSA 17A (07/01/2021)

PURPOSE: Use this form to apply for a title and/or to register a passenger vehicle, motorcycle, truck, motor home (RV), or trailer.

INSTRUCTIONS: Complete this form and return to any DMV customer service center (CSC). DMV may request proof of any information provided.

OWNER INFORMATION

 

APPLICATION TYPE:

 

 

Title

 

 

Electronic Title Option -- I want DMV to maintain an electronic certificate of

 

Check one:

 

 

 

 

 

Title and Registration (license plates issued)

title on file for this vehicle. (No paper title will be issued)

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check

 

 

Vehicle is owned by individual(s).

If this application is for joint ownership, do you wish clear rights of ownership to be transferred to

 

 

one:

 

 

 

Vehicle is business owned.

the surviving owner in the event of the death of either the owner or co-owner?

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S FULL LEGAL NAME (last, first, mi, suffix) OR BUSINESS NAME (if business owned)

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S FULL LEGAL NAME (last, first, mi, suffix)

 

 

 

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Owners (and Lessees if applicable) MUST provide their residence/home/business address where requested, this

RESIDENCE/BUSINESS JURISDICTION

address can not be a P.O. Box. You must complete form ISD-01 if you would like your address(es) updated.

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S STREET ADDRESS (Apt # if applicable)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S MAILING ADDRESS (if different from above)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S STREET ADDRESS (Apt # if applicable)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S MAILING ADDRESS (if different from above)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION WHERE VEHICLE IS PRINCIPALLY GARAGED

 

 

 

 

 

Are any of the owners/lessees on active

 

 

CITY

 

 

 

 

COUNTY

 

TOWN OF

 

 

 

 

 

military duty or service?

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF YOU WOULD LIKE YOUR REGISTRATION RENEWALS SENT TO AN ADDRESS OTHER THAN YOUR RESIDENCE/BUSINESS ADDRESS, ENTER IT BELOW.

 

 

 

 

REGISTRATION MAILING ADDRESS - OPTIONAL

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE INFORMATION

 

YEAR

 

MAKE

 

 

 

 

 

MODEL

 

 

 

 

 

BODY TYPE

 

 

 

 

VEHICLE IDENTIFICATION NUMBER (VIN)

 

 

 

 

 

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OF AXLES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY WEIGHT

GVWR (single vehicle weight - manufacturer)

GROSS WEIGHT (combined truck + attached trailer)

GCWR (combined weight: truck + attached trailer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FUEL

 

 

GAS

 

 

 

 

 

 

DIESEL

OTHER FUEL TYPE

 

 

 

VEHICLE

 

 

 

 

 

PRIMARY

 

IS THIS A LOW

 

 

YES

 

IS THIS A

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOGGING

 

 

 

 

 

 

TYPE

 

 

ELECTRIC

OTHER

 

 

 

 

 

 

 

 

 

 

COLOR

 

 

 

 

 

 

 

 

 

 

SPEED VEHICLE?

 

NO

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS VEHICLE STATE OR

 

 

YES - enter agency code

 

NO

DIVISION CODE

 

 

 

 

 

 

 

PREVIOUS TITLE NUMBER

 

 

 

 

 

 

STATE

 

 

 

 

 

 

 

LOCALITY-OWNED?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIEN INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS THERE A LIEN ON THIS VEHICLE?

 

YES - YOU MUST COMPLETE THIS SECTION

 

 

 

NO - SKIP TO THE NEXT SECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF FIRST LIEN (mm/dd/yyyy)

LIENHOLDER NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For additional liens, complete VSA 66 and attach to this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOURCE OF OWNERSHIP INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW WAS THIS VEHICLE SOLD TO YOU?

 

 

 

PURCHASE DATE (mm/dd/yyyy)

RENTOR NUMBER

 

 

 

 

 

 

VA DEALER LICENSE NUMBER

 

 

(check one)

 

 

USED

 

NEW

 

DEMONSTRATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEALERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

SALES PRICE

 

 

 

PROCESSING FEE

SALES AND USE TAX

 

 

VEHICLE PURCHASED FROM

 

 

 

 

MANUFACTURER REBATE/INCENTIVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEASE INFORMATION (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESSEE'S FULL LEGAL NAME (last, first, mi, suffix)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESSEE'S RESIDENCE/BUSINESS ADDRESS

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ODOMETER STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ODOMETER READING (no tenths)

 

 

 

Federal and state laws require that you state the mileage in connection with the transfer of ownership. Failure to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

complete the statement or providing a false statement may result in fines and/or imprisonment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify to the best of my knowledge that: (check one)

 

 

The odometer reading above is the ACTUAL MILEAGE of the vehicle.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The odometer reading above is NOT the ACTUAL MILEAGE. (Odometer discrepancy.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The odometer reading above is IN EXCESS of its mechanical limits.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle was exempt from disclosure in prior state of title (applicant must present out-of-state title showing exemption)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOG NUMBER ____________________________________

TITLE NUMBER ____________________________________

 

VSA 17A (07/01/2021) Page 2

PERSONAL PROPERTY TAX RELIEF ELIGIBILITY

 

1. Answer the questions below to determine if your vehicle qualifies for car tax relief.

YES NO

a.Is more than 50% of the vehicle's annual mileage used as a business expense for federal income tax purposes OR reimbursed by an employer?

 

b.

Is more than 50% of the depreciation associated with the vehicle deducted as a business expense for federal income tax purposes?

 

c.

Is the cost of the vehicle expensed pursuant to Section 179 of the Internal Revenue Service Code?

 

2.

d.

If the vehicle is leased by an individual, does the leasing company pay the tax without reimbursement from the individual?

If you answered YES to ANY of the above questions, check Business Use. Your vehicle is considered by State law to have a business use and does NOT

 

qualify for Personal Property Tax Relief.

BUSINESS USE

 

3.

If you answered NO to ALL of the above questions, check Personal Use and answer the question below.

 

 

 

PERSONAL USE -- Is this vehicle held in a private trust for non-business purposes by an individual beneficiary?

YES NO

INSURANCE CERTIFICATION

I/We certify that (check one):

This vehicle is insured by a liability policy issued through an insurance company licensed to do business in Virginia and it will remain insured while registered, whether or not it is operated. Penalties are severe for violation of this requirement. Be advised that the amount of liability coverage required is higher for vehicles that are operated for hire.

NAME OF INSURANCE COMPANY

This vehicle is not insured; therefore, I am remitting the applicable uninsured motor vehicle fee. (This fee provides no insurance coverage.) A vehicle must be insured with liability coverage when it is registered, and it must remain insured while registered, whether or not it is operated, or the uninsured motor vehicle fee must be paid. Penalties are severe for violation of this requirement.

REGISTRATION INFORMATION

NOTE: Virginia offers more than 200 unique plates for our customers. Please visit www.dmvNow.com for a listing of special plates available. Not all plates are available for all vehicle types and some special plates require a certification form. Review our website for additional information.

 

REGISTRATION PERIOD (check one:)

 

ONE YEAR

 

 

 

 

 

 

 

 

 

 

TWO YEARS ($2 discount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THREE YEARS ($3 discount - not for emissions area)

 

 

TRANSFER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(enter plate number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION TYPE (check one:)

 

PRIVATE

 

 

 

 

RENTAL

 

 

 

FOR HIRE (complete For Hire Information below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trailer Permanent - (one time fee) select size:

 

Regular size plate

 

Small size plate (trailer gross weight must be 4,000 lbs or less)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION RECORD INDICATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Communication Needs Indicator - For

 

myself or

 

a person who regularly occupies this vehicle, I request a DMV record indicator for a disability

 

 

 

 

 

 

 

 

that can impair communication. The adult occupant, parent, legal guardian of an individual who regularly occupies the vehicle who has a communication

 

 

 

 

impairment authorizes and consents to the release of their communication impairment information to employees and agents of criminal justice agencies as

 

 

defined in Virginia Code § 9.1-101.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR HIRE INFORMATION

Check to indicate how the vehicle being registered will be used (check all that apply). If the vehicle will be used in property carrier operations, and those operations exclusively use passenger cars, motorcycles, autocycles, mopeds, or vehicles with a gross vehicle weight rating (GVWR) of 10,000 pounds or less, then registration for hire is not required.

 

 

 

PASSENGER CARRIER OPERATIONS

 

 

 

 

 

 

PROPERTY CARRIER OPERATIONS

 

 

 

 

 

 

 

 

 

 

Common Carrier - Regular Route

 

Employee Hauler

 

 

Sight-seeing Carrier

 

 

 

Property Carrier *

 

 

 

 

 

 

 

 

Common Carrier - Irregular Route

 

Contract Passenger Carrier

 

 

Non-Emergency Medical Transport

 

 

 

Household Goods Carrier *

 

 

 

 

 

 

 

 

 

Nonprofit/Tax-Exempt

 

Taxicab

 

 

Exempt Operations - Passengers *

 

 

 

Exempt Operations - Property *

 

 

 

 

 

 

 

*You must also complete the For-Hire Vehicles Registration Request (MCS115)

Do you hold a valid intrastate operating authority certificate/permit? YES NO

If no, and you are a passenger carrier you must also complete the For-Hire Vehicles Registration Request (MCS115).

NOTICE

PRIVACY NOTICE: The information, including Social Security Number, is requested in accordance with Virginia Code §§46.2-623 and 46.2-629. Any person who refuses to supply the required information will be denied a certificate of title and/or registration. By signing this form, you authorize DMV’s exchange of title and registration records with business, law enforcement, or government entities and you authorize DMV’s exchange of title and registration records in accordance with Va. Code §§46.2-208 through 46.2-214 and 18 U.S.C. 2721.

POWER OF ATTORNEY FOR NON-RESIDENT(S) AND CORPORATION(S) NOT DOMICILED IN VIRGINIA: Pursuant to the provisions of Virginia Code §46.2-601, I/we appoint the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, to be my/our true and legal agent upon whom all legal processes against me/us may be served in any legal proceeding arising from the operation and/or use of any motor vehicle registered in my/our name(s) in the Commonwealth of Virginia. I/we agree that any lawful process or notice to me/us which is served on the Commissioner shall have the same legal effect as if served on me/us within the Commonwealth of Virginia.

CERTIFICATION

I/We 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.

APPLICANT NAME (print)

SIGNATURE OF APPLICANT

DATE (mm/dd/yyyy)

 

 

 

CO-APPLICANT NAME (print)

SIGNATURE OF CO-APPLICANT

DATE (mm/dd/yyyy)

 

 

 

DMV USE ONLY

PROOF OF ADDRESS (specify proof document(s) presented)

WITH LIEN?

 

YES

 

NO

UMV FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES PRICE

$

TITLE FEE

$

IF HELD, REASON:

 

 

 

CSR STAMP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROCESSING FEE

$

TRANSFER FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES & USE TAX

$

REGISTRATION FEE

$

TOTAL

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Edit Dmv Form Vsa 17A Online for Free

This PDF editor was made to be as easy as it can be. If you keep up with these steps, the process of preparing the vsa form document is going to be easy.

Step 1: To begin with, pick the orange "Get form now" button.

Step 2: You're now on the form editing page. You may edit, add text, highlight certain words or phrases, put crosses or checks, and insert images.

For you to prepare the form, enter the information the application will require you to for each of the following sections:

stage 1 to completing vsa17a

Remember to fill out the LOCATION WHERE VEHICLE IS, CITY, COUNTY, YES IF YOU WOULD LIKE YOUR, TOWN OF, STATE, ZIP CODE, Are any of the ownerslessees on, YEAR, MAKE, MODEL, VEHICLE INFORMATION BODY TYPE, VEHICLE IDENTIFICATION NUMBER VIN, NUMBER OF AXLES, and EMPTY WEIGHT GVWR single vehicle space with the expected particulars.

Entering details in vsa17a part 2

The application will ask you for particulars to conveniently fill out the box LESSEES FULL LEGAL NAME last first, TELEPHONE NUMBER, DMV CUSTOMER NUMBER FEIN SSN, LEASE INFORMATION if applicable, LESSEES RESIDENCEBUSINESS ADDRESS, CITY, STATE, ZIP CODE, ODOMETER READING no tenths, Federal and state laws require, ODOMETER STATEMENT, I certify to the best of my, The odometer reading above is the, The odometer reading above is NOT, and T T L E N U M B E R.

Finishing vsa17a part 3

It is important to define the rights and obligations of both sides in paragraph PERSONAL PROPERTY TAX RELIEF, Answer the questions below to, YES NO, b c d, Is more than of the vehicles, employer, Is more than of the depreciation, If you answered YES to ANY of the, qualify for Personal Property Tax, BUSINESS USE, If you answered NO to ALL of the, PERSONAL USE Is this vehicle held, YES, INSURANCE CERTIFICATION, and IWe certify that check one.

stage 4 to finishing vsa17a

End by reading the following fields and filling them out as needed: Check to indicate how the vehicle, PASSENGER CARRIER OPERATIONS, Common Carrier Regular Route, Employee Hauler Contract Passenger, Sightseeing Carrier NonEmergency, PROPERTY CARRIER OPERATIONS, You must also complete the, Do you hold a valid intrastate, YES, NOTICE, PRIVACY NOTICE The information, POWER OF ATTORNEY FOR NONRESIDENTS, IWe certify and affirm that all, APPLICANT NAME print, and SIGNATURE OF APPLICANT.

vsa17a Check to indicate how the vehicle, PASSENGER CARRIER OPERATIONS, Common Carrier  Regular Route, Employee Hauler Contract Passenger, Sightseeing Carrier NonEmergency, PROPERTY CARRIER OPERATIONS, You must also complete the, Do you hold a valid intrastate, YES, NOTICE, PRIVACY NOTICE The information, POWER OF ATTORNEY FOR NONRESIDENTS, IWe certify and affirm that all, APPLICANT NAME print, and SIGNATURE OF APPLICANT fields to fill out

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Step 4: To avoid different complications in the future, be sure to prepare minimally two or three duplicates of the file.

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