Dsd 27 A Form PDF Details

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QuestionAnswer
Form NameDsd 27 A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesyyyy, DSD, dsd27, purchasers

Form Preview Example

PERMIT TO USE DEALER OR TEMPORARY TRANSPORT DSD 27 A (08/10/2011)

PLATE ON TRUCKS OR TRACTOR TRUCKS

Purpose: Motor vehicle dealers use this form to permit bona fide prospective purchasers or their authorized agent to use a dealer or transport plate on trucks or tractor trucks - that may be laden - for a specified period of time or mileage.

Instructions: See reverse side for details

ASSIGNED OPERATOR INFORMATION

FULL LEGAL NAME (last)

 

(first)

(middle)

 

(suffix)

 

 

 

 

 

 

STREET ADDRESS

 

 

CITY

STATE

ZIP CODE

 

 

 

 

 

TELEPHONE NUMBER

FAX NUMBER

EMAIL ADDRESS

 

 

(

)

(

)

 

 

 

 

 

 

 

 

 

 

VEHICLE INFORMATION

VEHICLE IDENTIFICATION NUMBER (VIN)

VEHICLE YEAR

VEHICLE MAKE

 

 

VEHICLE MODEL

PLATE ISSUE INFORMATION

DATE ISSUED (mm/dd/yyyy)

TIME ISSUED

AM

PM

DATE EXPIRES (mm/dd/yyyy)

TIME EXPIRES

AM PM

VEHICLE MILEAGE AT ISSUANCE

DEALERSHIP CERTIFICATION

In accordance with Virginia Law, the following plate is approved/authorized to be used for 3 days or 750 miles (whichever comes first) Note: Dealer License Plates or Temporary Transport Plates may not be used on the same truck or tractor truck by the same prospective purchaser for a period of 60 days.

DEALER PLATE

DEALER PLATE NUMBER

TEMPORARY TRANSPORT PLATE

TRANSPORT PLATE NUMBER

I further 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.

DEALERSHIP NAME (print)

DEALER CERTIFICATE NUMBER

AUTHORIZED REPRESENTATIVE NAME (print)

AUTHORIZED REPRESENTATIVE TITLE (print)

AUTHORIZED REPRESENTATIVE SIGNATURE

DATE (mm/dd/yyyy)

(back of form)

Instructions for processing the permit to use a dealer's license plate or temporary transport plate for 3 days or 750 miles, whichever comes first.

1.Dealer completes permit, makes a copy and retains the copy in dealer records for a minimum of 5 years.

2.Dealer issues original permit to person authorized to use the license plate. Original permit must be in the immediate possession of the person operating or authorized to operate the truck or tractor truck.

3.Permit copies retained by the dealer are subject to inspection by authorized representatives of the Department of Motor Vehicles or the Motor Vehicle Dealer Board.

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