In the realm of vehicle management and legal compliance, the DMV VSA40 form plays a crucial role, especially within the jurisdiction of Virginia. This particular form, officially termed the Vehicle Removal Certificate, caters to a broad spectrum of individuals and entities—including private citizens, businesses, and governmental bodies—allowing them to meticulously document the removal, disposition, or changes in possession of motor vehicles, trailers, or manufactured homes. The essence of the VSA40 form lies in its ability to track these transitions, ensuring that all actions are in strict adherence to the Virginia Motor Vehicle Law. Its comprehensive structure not only captures detailed information about the vehicle, such as year, make, model, and Vehicle Identification Number (VIN) but also includes sections dedicated to the vehicle's current custodian, towing company data, and eventual disposition, whether it be obtaining a new title in the owner's name, auctioning, or transferring to a demolisher for scrapping. This document further emphasizes the importance of truthful declaration through required certifications under the penalty of perjury, highlighting the legal obligation of all parties involved to furnish accurate and genuine information. Additionally, it outlines specific instructions for completion and submission, underscoring its role as a critical instrument for maintaining public safety, legal compliance, and the orderly administration of vehicle status changes.
| Question | Answer |
|---|---|
| Form Name | Dmv Form Vsa40 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | demolisher, vsa 40 form, Virginia, VSA |
VEHICLE REMOVAL CERTIFICATE
VSA 40 (10/01/2011)
Purpose: This form is used by any person (individual, business, government; see VA Code
Instructions: Complete and submit this form following the instructions on the back of the form.
1. VEHICLE/TRAILER/MANUFACTURED HOME INFORMATION
VEHICLE YEAR
VEHICLE MAKE
VEHICLE MODEL
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE LOCATION
CITY
STATE
VA
ZIP CODE
VEHICLE TYPE |
|
AUTO |
|
MANUFACTURED HOME |
|
MOTORCYCLE |
|
TRAILER |
|
TRUCK |
|
OTHER _________________ |
|
|
|
|
|
|
|||||||
FULL NAME OF PERSON/AUTHORIZED AGENT IN POSSESSION OF VEHICLE |
|
|
|
|
TELEPHONE NUMBER |
|||||||
ADDRESS OF PERSON/AUTHORIZED AGENT IN POSSESSION OF VEHICLE CITY
STATE
ZIP CODE
I certify and affirm that all information presented in this section 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.
SIGNATURE OF PERSON/AUTHORIZED AGENT IN POSSESSION OF VEHICLE |
DATE (mm/dd/yyyy) |
|
|
2. TOWING COMPANY INFORMATION AND CERTIFICATION
The vehicle described → |
LICENSED VEHICLE REMOVER'S COMPANY NAME |
BTRO LICENSE NUMBER (or tow truck plate number) |
|||
above was released to |
|
|
|
|
|
|
|
|
|
|
|
ADDRESS |
|
CITY |
|
STATE |
ZIP CODE |
|
|
|
|
|
|
OPERATOR NAME (print)
TOWING COMPANY REPRESENTATIVE NAME (print) (if different than operator)
I certify and affirm that all information presented in this section 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.
TOWING COMPANY REPRESENTATIVE SIGNATURE
3. VEHICLE DISPOSITION
I certify and affirm that I have complied with all requirements of the Virginia Motor Vehicle law for the above vehicle, trailer, or manufactured home and am:
obtaining title in my name (signature required below), selling at auction (complete section 4), transferring to a demolisher or scrap metal processor. (complete section 5)
I further certify and affirm that all information presented in this section 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.
SIGNATURE OF PERSON/AUTHORIZED AGENT IN POSSESSION OF VEHICLE
4. SALE OF ABANDONED VEHICLE (AVP) INFORMATION
The vehicle described → |
PURCHASER NAME (print) |
|
|
|
above was sold to |
|
|
|
|
|
|
|
|
|
ADDRESS |
|
CITY |
STATE |
ZIP CODE |
|
|
|
|
|
PURCHASE PRICE
PURCHASE DATE (mm/dd/yyyy)
ONLINE AVP RECEIPT NUMBER (if applicable)
I certify and affirm that I have complied with all requirements of the Virginia Motor Vehicle law for the above abandoned vehicle, trailer or manufactured home and am eligible to transfer ownership to a third party. I further certify and affirm that all information presented in this section 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.
SELLER SIGNATURE
DMV HQ USE ONLY
Is the vehicle identification number (VIN) on the customer service system (CSS)? YES
NO
If VIN is not on CSS, is Abandoned Vehicle Receipt attached? |
|
YES |
|
NO Has the vehicle been previously entered as demolished? |
|
YES |
|
NO |
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
Is the vehicle recorded as stolen? |
|
YES |
|
NO |
|
|
|
If mercury switch was previously removed is VSA 40A attached? |
|
YES |
|
NO |
|
|
|
|
|
|
|
|
|
|
|
|
|
VSA 40 (10/01/2011)
Page 2
5. DEMOLISHER/SCRAP METAL PROCESSOR INFORMATION AND CERTIFICATION
As provided under VA Code, I have transferred possession of the above described vehicle to the licensed demolisher or scrap metal processor listed below for the purpose of demolition or conversion to scrap.
INDIVIDUAL/AUTHORIZED AGENT SIGNATURE (Transferor)
VEHICLE TRANSFER DATE (mm/dd/yyyy)
DEMOLISHER/SCRAP METAL PROCESSOR COMPANY NAME (Transferee)
BUSINESS LICENSE NUMBER
TELEPHONE NUMBER
CHECK ONE OF THE FOLLOWING OR STAMP THE BLANK SPACE BELOW WITH APPROVED MERCURY SWITCH STAMP:
The mercury switches have been removed from the vehicle, were previously removed from the vehicle, or the vehicle was not manufactured with mercury switches.
The mercury switches could not be removed from the vehicle because upon attempt it was determined removal of the switches would be impractical, unreasonable or unsafe.
I certify that the vehicle has been demolished/scrapped. I further certify and affirm that all information presented in this section 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.
DEMOLISHER/SCRAP METAL PROCESSOR REPRESENTATIVE SIGNATURE
DATE DEMOLISHED OR SCRAPPED (mm/dd/yyyy)
INSTRUCTIONS
Section 1: The person or authorized agent in possession of the vehicle, trailer or manufactured home completes the vehicle and applicant information, and signs.
Section 2: The licensed vehicle remover completes and signs this section if the vehicle is towed. DMV must receive the original VSA 40 form.
Section 3: The person or authorized agent in possession of the vehicle, trailer or manufactured home must indicate his or her intent to title, sell or transfer the vehicle, trailer or manufactured home for demolition.
Section 4: The person or authorized agent in possession of a vehicle, trailer, or manufactured home that has been processed using DMV's online Abandoned Vehicle Process (AVP), completes this section and provides the purchaser with the AVP receipt and the completed, signed VSA 40 for use in titling the vehicle unless transferred directly to a licensed demolisher (See Section 5).
Section 5: The person or authorized agent transferring possession of the vehicle, trailer or manufactured home to a licensed demolisher or scrap metal processor signs this section and transfers this form with the vehicle to the demolisher/scrap metal processor. The licensed demolisher or scrap metal processor completes this section to certify that the vehicle, trailer or manufactured home was demolished or scrapped. A license number, signature, date and telephone number are required.
Manual Reporting of Vehicle Disposition to DMV:
Licensed demolishers or scrap metal processors, who do not report vehicle disposition electronically per Va. Code
Data Integrity Room 516
Post Office Box 27412 Richmond, Virginia
NOTE: A copy of this VSA 40 form must be retained by the demolisher/scrap metal processor in accordance with the requirements in VA Code
Electronic Reporting of Vehicle Disposition to DMV:
Licensed demolishers or scrap metal processors who report vehicle disposition electronically to DMV per Va. Code
COMMENTS (Use the area below to enter any additional information.)