Dmv Form Vsa 17A PDF Details

Are you looking for a form to help you complete your vehicle registration? If so, look no further than Dmv Form Vsa 17A. This form is used to register a vehicle in Virginia and can be found on the Virginia Department of Motor Vehicles website. Completing this form is easy, and it will help ensure that your vehicle is registered correctly. Make sure to submit your completed form to the DMV as soon as possible to avoid any penalties.

Here is the details regarding the PDF you were looking for to fill out. It can tell you how long it will need to finish dmv form vsa 17a, exactly what fields you need to fill in, and so on.

QuestionAnswer
Form NameDmv Form Vsa 17A
Form Length2 pages
Fillable?Yes
Fillable fields132
Avg. time to fill out26 min 58 sec
Other namesvirginia dmv title, dmv vsa, virginia dmv online services title, vsa form 17a

Form Preview Example

APPLICATION FOR

CERTIFICATE OF TITLE AND REGISTRATION

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACQUISITION TYPE (check all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original Title is Electronic

 

 

Court Order

 

 

 

 

 

Replica

 

 

 

 

 

 

 

 

Converted Electric

 

 

 

 

Repossession (Vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(No paper attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

must be in your possession)

 

 

 

Leased

 

 

 

 

 

 

 

 

 

 

 

Replevin

 

 

 

 

 

 

 

 

Reconstructed

 

 

 

 

Abandoned Vehicle

 

 

 

 

Beneficiary Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Complete VSA 40)

 

 

 

 

(Complete VSA 18)

 

 

 

 

 

Rental

 

 

 

 

 

 

 

 

 

 

 

Seizure

 

 

 

 

 

 

 

 

Specially Constructed

 

 

 

 

Mechanic's Lien/Storage Lien

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Complete VSA 41)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOG

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 RESIDENCE/HOME/BUSINESS ADDRESS (Apt # if applicable)

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S RESIDENCE/HOME/BUSINESS ADDRESS (Apt # if applicable)

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TITLE

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER

DATE OF SECOND LIEN (mm/dd/yyyy)

 

 

 

LIENHOLDER NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YEAR

 

MAKE

 

 

 

 

 

 

 

 

 

MODEL

 

 

 

 

 

 

 

BODY TYPE

 

VEHICLE IDENTIFICATION NUMBER (VIN)

 

 

 

 

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OF AXLES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY WEIGHT

GROSS WEIGHT

 

GROSS VEHICLE

 

 

 

 

 

 

GROSS COMBINATION

 

 

 

 

 

IS VEHICLE POWERED BY AN ALL ELECTRIC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT RATING

 

 

 

 

 

 

WEIGHT RATING

 

 

 

 

 

ENGINE?

 

 

 

 

 

YES

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(GVWR)

 

 

 

 

 

 

 

 

 

(GCWR)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FUEL TYPE

 

VEHICLE

PRIMARY

SECONDARY

 

 

PREVIOUS TITLE NUMBER

 

 

 

STATE

IS THIS A LOW

 

YES

IS THIS A

 

YES

 

 

 

 

 

 

 

 

 

 

COLOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPEED VEHICLE?

 

 

NO

LOGGING

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS VEHICLE STATE OR

 

YES - enter agency code

AGENCY CODE

 

 

 

NAME OF UNIT HAVING OPERATIONAL CONTROL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCALITY-OWNED?

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSONAL PROPERTY TAX RELIEF ELIGIBILITY (Passenger vehicles only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOURCE OF OWNERSHIP INFORMATION

 

VA DEALER LICENSE NUMBER

HOW WAS THIS VEHICLE SOLD TO YOU?

 

RENTOR NUMBER

PURCHASE DATE (mm/dd/yyyy)

DEALERS

 

(check one)

 

USED

 

NEW

 

DEMONSTRATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUFACTURER REBATE/INCENTIVE

SALES PRICE

 

PROCESSING FEE

SALES AND USE TAX

VEHICLE PURCHASED FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET 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.

The model year is at least 10 years or older than the current calendar year and was exempt from odometer disclosure in the prior state of title. (Applicant must present the out-of-state title showing the exemption)

REGISTRATION INFORMATION

REGISTRATION PERIOD (check one:)

 

ONE YEAR

 

TWO YEARS ($2 discount applies)

 

TRANSFER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(enter plate number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION TYPE (check one:)

 

PRIVATE

 

RENTAL

 

FOR HIRE (complete For Hire Information below)

 

 

 

 

 

 

 

 

 

 

FOR HIRE INFORMATION

Check to indicate how the vehicle being registered will be used. (check all that apply)

 

 

 

 

PASSENGER CARRIER OPERATIONS

 

 

 

 

 

 

 

PROPERTY CARRIER OPERATIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Common Carrier - Regular Route

 

Employee Hauler

 

 

Sight-seeing Carrier

 

 

 

Bulk Property Carrier

 

 

 

 

 

 

 

 

 

 

 

 

Common Carrier - Irregular Route

 

Contract Passenger Carrier

 

 

Non-Emergency Medical Transport

 

 

 

Property Carrier

 

 

 

 

 

 

 

 

 

 

 

 

Nonprofit/Tax-Exempt

 

Taxicab

 

 

Exempt Operations - Passengers *

 

 

 

Household Goods Carrier

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

Exempt Operations - Property

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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).

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF PLATE REQUESTED

Select requested plate type: (see note below)

 

Special Plate (enter type)

 

 

 

 

 

(examples: Cardinal, Great Seal, Heritage, etc.)

 

 

 

 

 

 

 

 

 

 

Trailer Permanent - (one time fee) select size:

 

Regular size plate

 

 

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

 

For Hire Plate (enter description):

 

 

(examples: Taxi, Passenger For Hire, Truck For Hire, Tow Truck, Tractor For Hire, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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.

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.

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)

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. Title and registration records may be disseminated in accordance with §§46.2-208 through 46.2-214, to business, law enforcement or authorized government entities.

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.

 

 

 

 

 

 

 

 

 

 

 

DMV USE ONLY

 

 

 

WITH LIEN?

 

YES

 

NO

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLATE NUMBER

 

 

 

 

PLATE TYPE

 

EXPIRATION DATE

 

IF HELD, REASON:

 

CSR STAMP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES PRICE

$

 

 

 

 

TITLE FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROCESSING FEE

$

 

 

 

TRANSFER FEE

$

 

 

 

 

 

 

 

 

 

UMV FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES & USE TAX

$

 

 

 

REGISTRATION FEE

$

 

 

 

 

 

 

 

 

 

WEIGHT

$

 

 

DEALER SURCHARGE

$

 

 

PERSONALIZED PLATE FEE

$

 

INCREASE FEE

 

 

 

 

 

 

HYBRID/ELECTRIC

$

TOTAL

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Edit Dmv Form Vsa 17A Online for Free

Our PDF editor makes it easy to manage the dmv application certificate title form. It will be easy to obtain the file immediately by using these easy steps.

Step 1: Select the button "Get form here" to open it.

Step 2: As you enter our dmv application certificate title editing page, you will notice each of the actions you can undertake about your document at the upper menu.

You should type in the following information to create the dmv application certificate title PDF:

certificate title gaps to fill out

Put the necessary particulars in the LESSEE'S FULL LEGAL NAME (last, TELEPHONE NUMBER, DMV CUSTOMER NUMBER / FEIN / SSN, L O G N U M B E R _ _ _ _ _ _ _ _, T T L E N U M B E R _ _ _ _ _ _ _, LESSEE'S RESIDENCE/BUSINESS ADDRESS, CITY, STATE, ZIP CODE, IS THERE A LIEN ON THIS VEHICLE, DATE OF FIRST LIEN (mm/dd/yyyy), YES - YOU MUST COMPLETE THIS, NO - SKIP TO THE NEXT SECTION, LIEN INFORMATION, LIENHOLDER MAILING ADDRESS, DATE OF SECOND LIEN (mm/dd/yyyy), LIENHOLDER NAME, LIENHOLDER MAILING ADDRESS, CITY, CITY, YEAR, MAKE, MODEL, VEHICLE INFORMATION BODY TYPE, VEHICLE IDENTIFICATION NUMBER (VIN), LIENHOLDER CODE, STATE, ZIP CODE, LIENHOLDER CODE, STATE, ZIP CODE, NUMBER OF AXLES, EMPTY WEIGHT GROSS WEIGHT GROSS, GROSS COMBINATION WEIGHT RATING, IS VEHICLE POWERED BY AN ALL, and YES YES IS THIS A LOGGING NO part.

certificate title LESSEE

Determine the key particulars in the T T L E N U M B E R _ _ _ _ _ _ _, EMPTY WEIGHT GROSS WEIGHT GROSS, GROSS COMBINATION WEIGHT RATING, FUEL TYPE, VEHICLE COLOR, PRIMARY, SECONDARY, PREVIOUS TITLE NUMBER, STATE, IS THIS A LOW SPEED VEHICLE, YES YES IS THIS A LOGGING NO, YES, IS VEHICLE STATE OR LOCALITY-OWNED, YES - enter agency code, AGENCY CODE, NAME OF UNIT HAVING OPERATIONAL, YES NO, PERSONAL PROPERTY TAX RELIEF, employer, NOT qualify for Personal Property, BUSINESS USE, PERSONAL USE -- Is this vehicle, and YES segment.

stage 3 to entering details in certificate title

The SOURCE OF OWNERSHIP INFORMATION, VA DEALER LICENSE NUMBER, DEALERS, HOW WAS THIS VEHICLE SOLD TO YOU, USED, NEW, DEMONSTRATOR, RENTOR NUMBER, PURCHASE DATE (mm/dd/yyyy), ONLY MANUFACTURER REBATE/INCENTIVE, SALES PRICE, PROCESSING FEE, SALES AND USE TAX, VEHICLE PURCHASED FROM, STREET ADDRESS, CITY, STATE, ZIP CODE, ODOMETER STATEMENT, ODOMETER READING (no tenths), Federal and state laws require, I certify to the best of my, The odometer reading above is the, The odometer reading above is NOT, The odometer reading above is IN, REGISTRATION PERIOD (check one:), REGISTRATION TYPE (check one:), ONE YEAR, TWO YEARS ($2 discount applies), TRANSFER, (enter plate number), PRIVATE, RENTAL, FOR HIRE (complete For Hire, REGISTRATION INFORMATION, FOR HIRE INFORMATION, and Check to indicate how the vehicle area could be used to point out the rights and responsibilities of all sides.

part 4 to completing certificate title

Prepare the template by reading the following sections: Select requested plate type: (see, Special Plate (enter type) Trailer, Regular size plate, Small size plate (trailer gross, (examples: Cardinal, For Hire Plate (enter description):, (examples: Taxi, NOTE: Virginia offers more than, are available for all vehicle, I/We certify that (check one):, INSURANCE CERTIFICATION, This vehicle is insured by a, This vehicle is not insured;, I/We certify and affirm that all, APPLICANT NAME (print), SIGNATURE OF APPLICANT, DATE (mm/dd/yyyy), and CERTIFICATION.

certificate title Select requested plate type: (see, Special Plate (enter type) Trailer, Regular size plate, Small size plate (trailer gross, (examples: Cardinal, For Hire Plate (enter description):, (examples: Taxi, NOTE: Virginia offers more than, are available for all vehicle, I/We certify that (check one):, INSURANCE CERTIFICATION, This vehicle is insured by a, This vehicle is not insured;, I/We certify and affirm that all, APPLICANT NAME (print), SIGNATURE OF APPLICANT, DATE (mm/dd/yyyy), and CERTIFICATION blanks to fill

Step 3: Choose the button "Done". Your PDF file can be transferred. You can obtain it to your pc or email it.

Step 4: To prevent yourself from potential upcoming challenges, it's always advisable to get a minimum of a couple of duplicates of each separate file.

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