Dmv Form Vsa40 – Fill Out and Use This PDF

Purpose: This form is used by any person (individual, business, government; see VA Code §1-230) or their authorized agent(s) to track and record the removal and/or disposition of a motor vehicle, trailer or manufactured home in their possession.

Instructions: Complete and submit this form following the instructions on the back of the form.

1. VEHICLE/TRAILER/MANUFACTURED HOME INFORMATION

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.

2. TOWING COMPANY INFORMATION AND CERTIFICATION

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

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

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.

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.

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 §46.2-1608.2, return the original VSA 40 form and applicable documents as required to DMV at the following address: Virginia Department of Motor Vehicles

Data Integrity Room 516

Post Office Box 27412 Richmond, Virginia 23269-0001

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 §46.2-1206.

Electronic Reporting of Vehicle Disposition to DMV:

Licensed demolishers or scrap metal processors who report vehicle disposition electronically to DMV per Va. Code §46.2-1608.2 shall retain the original VSA 40 form, proof of ownership document(s) and applicable DMV forms (as required), on file in a secure location for at least five years in accordance with the requirements in Va. Code §46.2-1206. These files are subject to inspection by law-enforcement.

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