Dmv Form Vsa 17B PDF Details

DMV Form VSA-17b is a form used to apply for a duplicate Vermont driver's license or learner's permit. If you have lost your driver's license or learner's permit, or if it has been stolen or damaged, you can use this form to apply for a replacement. The process for obtaining a duplicate driver's license or learner's permit is simple, and the DMV will typically issue the replacement document within days of receiving your application. Make sure you have all of the required information before you start the application process, and be prepared to pay the applicable fees.

QuestionAnswer
Form NameDmv Form Vsa 17B
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvsa17b how to complete a vsa17b form

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APPLICATION FOR CERTIFICATE OF TITLE - MANUFACTURED HOME

VSA 17B (07/01/2013)

Purpose: Use this form to title a manufactured home. Do not use for self-propelled vehicles or travel trailers.

Instructions: Complete this form and return to any DMV customer service center. DMV may request proof of any information provided.

 

 

 

 

ACQUISITION TYPE

 

 

 

 

 

 

 

 

 

LOG

 

Check if applicable:

 

 

 

 

 

 

 

 

 

 

 

 

Seizure

 

Replacement VIN

 

Abandoned Vehicle (Complete form VSA 40)

NUMBER

 

 

 

 

 

 

Leased

 

(No paper attached)

 

Repossession (Vehicle must be in your possession)

 

 

 

Court Order

 

 

 

 

Mechanic's Lien/Storage Lien (Complete form VSA 41)

 

Original Title is Electronic

 

Beneficiary Information (Complete form VSA 18)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER INFORMATION

If this application is for joint ownership, do you wish clear rights of ownership to be transferred to the surviving owner in the event of the death of either

the owner or co-owner?

 

Yes

 

No

Electronic Title - Check this box if you do not want a paper title issued to you. An electronic Certificate of Title will remain on file for this vehicle at DMV.

OWNER FULL LEGAL NAME

(last, first, middle, suffix)

 

 

 

 

SOCIAL SECURITY NUMBER/FEIN

 

 

 

 

 

 

 

OWNER FULL LEGAL NAME

(last, first, middle, suffix)

 

 

 

 

SOCIAL SECURITY NUMBER/FEIN

 

 

 

 

 

 

Are any of the vehicle owners on active military duty or service?

 

Yes

 

No

 

 

If you change your residence/home address or mailing address to a non-Virginia address, your driver's license and/or photo identification (ID) card may be canceled.

RESIDENCE/HOME ADDRESS (Apt. # if applicable)

CITY

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (if different from above)

CITY

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER RESIDENCE ADDRESS (if different from above)

CITY

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

RESIDENCE JURISDICTION

LOCATION WHERE VEHICLE IS PRINCIPALLY GARAGED (check one)

 

 

 

 

 

CITY

 

COUNTY

 

TOWN of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIEN INFORMATION

Is there a lien on this vehicle?

 

 

Yes

 

No

If yes, you must complete this section.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST LIEN DATE (mm/dd/yyyy)

LIENHOLDER NAME

 

 

LIENHOLDER CODE

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

CITY/TOWN

 

STATE

ZIP CODE

 

 

 

 

 

 

 

SECOND LIEN DATE (mm/dd/yyyy)

LIENHOLDER NAME

 

 

LIENHOLDER CODE

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

CITY/TOWN

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

 

MANUFACTURER REBATE/INCENTIVE

SALES PRICE

 

 

PROCESSING FEE

SALES AND USE TAX

VEHICLE PURCHASED FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

CITY

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

TITLE NUMBER

VSA 17B (07/01/2013) page 2

MANUFACTURED HOME INFORMATION

MANUFACTURER

 

 

 

 

 

 

TYPE

 

MODEL

 

 

 

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PREVIOUS TITLE NUMBER

 

 

STATE

SERIAL NUMBER

 

 

HOME DIMENSIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LENGTH

 

FT. x WIDTH

FT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME ADDRESS

 

 

 

 

CITY

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS VEHICLE STATE OR

 

 

YES - enter agency code

AGENCY CODE

 

 

NAME OF UNIT HAVING OPERATIONAL CONTROL

 

 

 

 

LOCALITY-OWNED?

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION

I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.

APPLICANT SIGNATURE

DATE (mm/dd/yyyy)

CO-APPLICANT SIGNATURE

DATE (mm/dd/yyyy)

PRIVACY ACT NOTICE

The information, including Social Security Number, is requested in accordance with Virginia Code §46.2-623. Any person who refuses to supply the required information will be denied a Certificate of Title. Title records may be disseminated in accordance with §§ 46.2-208 through 46.2-214, to business, law enforcement or authorized government entities.

 

 

 

 

 

DMV USE ONLY

 

 

 

WITH LIEN?

 

 

PROOF OF ADDRESS (specify)

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF HELD, REASON

 

 

 

 

 

 

 

CLERK STAMP

 

 

 

 

 

 

 

 

 

 

SALE PRICE

 

$

TITLE FEE

$

 

DEALER SURCHARGE

$

 

 

 

 

 

 

 

 

 

 

 

 

PROCESSING FEE

 

$

UMV FEE

$

 

DHCD* (30.00)

$

 

 

 

 

 

 

 

 

 

 

 

 

TAX

 

$

TRANSFER FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBTOTAL

 

$

SUBTOTAL

$

 

SUBTOTAL

$

TOTAL

$

 

 

 

 

 

 

 

 

 

 

*Department of Housing and Community Development fee collected from Manufactured Home Dealer when manufactured home is titled.

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This PDF doc needs some specific information; to guarantee accuracy and reliability, make sure you adhere to the recommendations just below:

1. You will want to complete the Dmv Form Vsa 17B accurately, thus be careful when filling out the sections that contain all these blank fields:

Best ways to fill out Dmv Form Vsa 17B part 1

2. Once your current task is complete, take the next step – fill out all of these fields - LIEN INFORMATION, Is there a lien on this vehicle If, Yes, FIRST LIEN DATE mmddyyyy, LIENHOLDER NAME, LIENHOLDER CODE, LIENHOLDER MAILING ADDRESS, CITYTOWN, STATE, ZIP CODE, SECOND LIEN DATE mmddyyyy, LIENHOLDER NAME, LIENHOLDER CODE, LIENHOLDER MAILING ADDRESS, and CITYTOWN with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step no. 2 in completing Dmv Form Vsa 17B

3. The following section should also be relatively straightforward, MANUFACTURER, TYPE, MODEL, YEAR, MANUFACTURED HOME INFORMATION, PREVIOUS TITLE NUMBER, STATE, SERIAL NUMBER, HOME DIMENSIONS LENGTH, FT x WIDTH, HOME ADDRESS, CITY, STATE, ZIP CODE, and IS VEHICLE STATE OR LOCALITYOWNED - every one of these blanks needs to be filled in here.

Filling in part 3 in Dmv Form Vsa 17B

4. Filling in WITH LIEN, Yes, IF HELD REASON, SALE PRICE, PROCESSING FEE, TAX, SUBTOTAL, PROOF OF ADDRESS specify, TITLE FEE, UMV FEE, TRANSFER FEE, SUBTOTAL, DEALER SURCHARGE, DHCD, and SUBTOTAL is crucial in the next part - make sure to spend some time and fill out every field!

PROCESSING FEE, SUBTOTAL, and SUBTOTAL in Dmv Form Vsa 17B

As to PROCESSING FEE and SUBTOTAL, be sure you take another look in this current part. These are viewed as the most significant ones in the document.

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