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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.

Question	Answer
Form Name	Dmv Form Vsa 17A
Form Length	2 pages
Fillable?	Yes
Fillable fields	1
Avg. time to fill out	42 sec
Other names	virginia dmv online services title, vsa form 17a, va title, virginia title

12

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)

<![endif]>LOG NUMBER ____________________________________

<![endif]>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?
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

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


SALES PRICE	$	TITLE FEE	$	IF HELD, REASON:						CSR STAMP
SALES PRICE	$	TITLE FEE	$

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 17a 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 virginia dmv title

Remember to fill out the STATE, CITY, ZIP, CODE YEAR, MAKE, MODEL, VEHICLE, INFORMATION, BODY, TYPE VEHICLE, IDENTIFICATION, NUMBER, V, IN NUMBER, OF, AXLES GAS, ELECTRIC DIESEL, OTHER OTHER, FUEL, TYPE VEHICLE, COLOR PRIMARY, and IS, THIS, A, LOW, SPEED, VEHICLE space with the expected particulars.

Entering details in virginia dmv title part 2

The application will ask you for particulars to conveniently fill out the box STREET, ADDRESS CITY, STATE, ZIP, CODE LEASE, INFORMATION, if, applicable TELEPHONE, NUMBER D, MV, CUSTOMER, NUMBER, FEIN, S, SN LESSEES, RESIDENCE, BUSINESS, ADDRESS CITY, STATE, ZIP, CODE ODOMETER, READING, no, tenths ODOMETER, STATEMENT and T, TLE, NUMBER

Finishing virginia dmv title part 3

It is important to define the rights and obligations of both sides in paragraph employer, bcd, YES, NO qualify, for, Personal, Property, Tax, Relief BUSINESS, USE YES, INSURANCE, CERTIFICATION I, We, certify, that, check, one NAME, OF, INSURANCE, COMPANY REGISTRATION, INFORMATION REGISTRATION, PERIOD, check, one REGISTRATION, TYPE, check, one TWO, YEARS, discount, TRANSFER enter, plate, number and PRIVATE.

stage 4 to finishing virginia dmv title

End by reading the following fields and filling them out as needed: PASSENGER, CARRIER, OPERATIONS YES, NOTICE, SIGNATURE, OF, APPLICANT DATE, mm, dd, yyyy CERTIFICATION, CO, APPLICANT, NAME, print SIGNATURE, OF, CO, APPLICANT DATE, mm, dd, yyyy D, MV, USE, ONLY WITH, LIEN YES, and U, MV, FEE

virginia dmv title PASSENGERCARRIEROPERATIONS, YES, NOTICE, SIGNATUREOFAPPLICANT, DATEmmddyyyy, CERTIFICATION, COAPPLICANTNAMEprint, SIGNATUREOFCOAPPLICANT, DATEmmddyyyy, DMVUSEONLY, WITHLIEN, YES, and UMVFEE fields to fill out

Step 3: As soon as you click the Done button, the finished document is easily transferable to any kind of of your gadgets. Or alternatively, you may deliver it by means of mail.

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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