Form Ta Vd 119 PDF Details

The TA-VD-119 form serves as a comprehensive document designed to facilitate a variety of vehicle-related transactions within the state of Vermont. From the issuance of new registrations and the transfer of existing ones to the renewal of vehicle plates and replacement of lost, stolen, or seized plates, this form encompasses a broad range of purposes tailored to meet the needs of vehicle owners and lessees. It meticulously records details about the vehicle in question, such as make, model, year, body type, mileage, and the vehicle identification number (VIN), ensuring a rigorous process for the authentication and registration of vehicles. Furthermore, it caters to a diverse set of vehicle types including, but not limited to, school buses, pleasure cars, conservation plates, and motorcycles, among others. The form also addresses ownership details, allowing for the specification of rights of survivorship, thereby streamlining the process of vehicle inheritance. On a legal and regulatory front, it mandates the acknowledgment of the Federal Motor Carrier Safety Regulations for commercial vehicles, reinforcing the state's commitment to road safety and compliance. Additionally, the form plays a crucial role in the financial aspects of vehicle ownership, including the calculation of purchase and use tax. Through its detailed and structured format, the TA-VD-119 form embodies Vermont's effort to ensure a thorough, legally compliant, and efficient vehicle registration process.

QuestionAnswer
Form NameForm Ta Vd 119
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesTRK, LESSOR, Verifications, VFW

Form Preview Example

 

Old #1

IN LIEU PLATE

TEMP PLATE DATE

490

C or

REG TYPE

INDEX #

 

EXPIRES

DO NOT WRITE IN

 

 

 

 

 

 

 

 

 

 

 

SHADED AREAS

 

 

 

490

P

 

 

 

/

 

 

 

 

 

 

 

DMV Copy

New #1

New #2

Title Code

225

227

231

232

233

452

 

 

 

 

TA-VD-119 06/2013

 

 

 

453

454

455

465

LP

2 Year

 

 

 

 

 

1A

 

TRANSACTION TYPE

 

1B

PLATE TYPE

SCHOOL BUS (19)

VFW (52)

ATV (02)

MUNICIPAL (15)

 

 

 

PLATE #____________________

PLEASURE CAR (19)

CONSERVATION PLATE (48, 57)

US VET (49)

EMS (46)

FREEMASONS (54)

VANITY

BUILDING BRIGHT FUTURES (55)

NATIONAL GUARD (41)

VOLUNTEER (28)

ROTARY (53)

NEW (421)

DISABLED PLATE

OFF-HWY TRACTOR (24)

PURPLE HEART (47)

FIREFIGHTER (40)

MOTOR BUS (04, 05)

TRANSFER (431)

TRUCK (27)

AGRICULTURE (01) FARM USE ONLY

POW (23)

JITNEY/RENTAL (37)

STATE (22)

 

 

 

 

 

RENEW (475)

TRAILER (26, 25, 06)

SPECIAL PURPOSE TRK CAT I (11)

VIETNAM VET (50)

ANTIQUE (03) (AN)

STREET ROD (56)

REPLACEMENT PLATE

MOTORCYCLE (18)

SPECIAL PURPOSE TRK CAT II (20)

AMERICAN LEGION (38)

EXHIBITION (09) (EX)

FARM TRACTOR (45)

LOST STOLEN SEIZED

MOTOR HOME (19)

AMATEUR RADIO OPR (42)

SHERIFF (43)

LIONS CLUB (51)

Motor Driven Cycle (17)

IRP TAX & TITLE

WEIGHT CHANGE

2

MAKE

 

 

MODEL

MODEL YEAR

BODY TYPE

MILEAGE (NO TENTHS)

MILES

COLOR

 

 

 

 

 

 

 

 

 

KM HOURS

 

SERIAL NUMBER (VIN)

 

 

 

 

 

NO OF CYL

VEHICLE IS

GAS

DIESEL

HYBRID

 

 

 

 

 

 

 

NEW USED REBUILT

ELECTRIC PROPANE OTHER

3A

TRUCKS (including Pick-Up & Farm)

3B

TRAILERS

 

3C

ATV/MDCMOTORCYCLE

3D BUS/JITNEY/RENTAL

EMPTY

 

 

LOADED

 

EMPTY

 

LOADED WEIGHT

# Wheels

CC’s

EMPTY

 

 

 

 

 

 

 

WEIGHT

 

 

WEIGHT

 

WEIGHT

 

1500 or (26)

WEIGHT

 

 

 

 

 

 

 

 

 

# OF AXLES

BRAKE TYPE

 

LENGTH x WIDTH (FT)

 

 

 

# OF

 

 

 

 

 

 

 

 

 

HYD

AIR

OTHER

 

 

1501 or (25)

 

 

 

PASSENGERS

 

 

 

 

 

 

 

LOADED

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT

 

 

4A

OWNER

VT DRIVER LICENSE NO

SSN or FEDERAL ID NUMBER

GENDER

CO-OWNER

VT DRIVER LICENSE NO

SSN or FEDERAL ID NUMBER

GENDER

 

 

LESSEE

 

 

M F

LESSOR

 

 

M F

Name

 

 

 

 

Name

 

 

 

Mailing Address (PO Box or Street)

Mailing Address (PO Box or Street)

City:

State:

ZIP:

City:

State:

ZIP:

Physical Address (Street)

Physical Address (Street)

City:

State:

ZIP:

City:

State:

ZIP:

Date of birth

If name has changed, list previous name

Date of birth

If name has changed, list previous name

Phone Number & Email Address:

 

4B

 

 

MUST INDICATE RIGHTS OF SURVIVORSHIP (CHECK ONE BELOW) IF NO BOX IS CHECKED “JOINT TENANTS” WILL BE SELECTED

 

 

Spouses

Joint Tenants

Tenants In Common

Partners (business)

TOD (Transfer on Death)

Date of loan

VT license # (if individual)

Date of birth (if individual)

Name of person/company vehicle acquired from

Date purchased

5A

 

 

5B

 

Lienholder Name

Lienholder Address

 

Address of person/company vehicle acquired from

 

City

State

Zip

Signature of person/company (agent) vehicle acquired from

Dealer number

 

6A

 

 

 

 

6B

 

 

 

 

 

 

 

 

9

 

 

 

 

Purchase Price

 

 

 

Complete Section 6B to Claim Tax Credit or to Transfer Plates

 

DO NOT WRITE IN SHADED AREA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PURCHASE PRICE

$

 

PURCHASER OF OLD VEHICLE

 

 

 

Registration

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX CREDIT

$

 

CITY

 

 

 

STATE

 

ON (DATE)

Tax

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NET TAXABLE COST

$

 

YEAR

 

 

 

MAKE

PLATE

 

TAX EXEMPT #

Title

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX (6%)

 

$

 

VIN

 

 

 

 

 

 

 

Transfer

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

VERIFICATION OF VEHICLE IDENTIFICATION NUMBER - APPLICANT SHOULD NOT WRITE IN THIS SECTION

Warranty Fee

$5.00

12

NEW Vehicles Only

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

STATE OF REG

 

Fuel User

31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

AT TOWN OR CITY

 

STATE

Other

 

 

 

 

 

 

 

 

 

 

 

AUTHORIZED SIGNATURE

 

ORGANIZATION

Total Fees

 

 

 

 

 

 

 

 

 

NCIC

VINASSIST

CERTIFICATE NUMBER

PHONE NUMBER

MILEAGE (NO TENTHS)

MILES KM HOURS

Return #

Rater #

RF

 

 

Y N

Y N

 

 

 

 

 

 

 

 

 

 

The owner certifies that this vehicle 1) is properly equipped and in good mechanical condition; 2) was

 

 

As the applicant for registration of a commercial motor vehicle, which is a motor vehicle with a gross

 

 

8

 

placed into use on or before the date this application was signed; 3) currently has liability insurance in

 

 

vehicle weight rating of 10,001 lbs. or more; is a vehicle that is used to transport hazardous materials;

 

 

 

 

 

effect as required by 23 V.S.A. §800 (a).

If transfer of plates, the owner and/or this vehicle are not

 

 

or is a vehicle that is designed to transport 16 or more passengers, including the driver, I hereby declare

 

 

 

under suspension pursuant to 23 V,S,A, §3009 (b) [diesel tax related]. Statements and warrants herein

 

 

that I have knowledge of the Federal Motor Carrier Safety Regulations, Title 49 of the Code of Federal

 

 

 

 

 

 

 

 

 

 

are certified under penalty of 23 V.S.A. §202, §203, §2082, and 32 V.S.A. §§ 8901-8915.

 

 

Regulations, as adopted by the State of Vermont.

 

SIGNATURE (OWNER/LESSEE)

 

DATE

 

 

SIGNATURE (CO-OWNER/LESSOR)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Old #1

 

 

 

 

 

IN LIEU PLATE

 

 

 

 

 

 

 

 

TEMP PLATE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPIRES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

490 C or

 

 

 

REG TYPE

 

 

 

 

 

 

 

 

INDEX #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

490 P

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

Customer Copy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TA-VD-119 06/2013

 

 

New #1

 

 

 

 

 

New #2

 

 

 

 

 

 

 

 

 

 

 

 

 

Title Code

 

 

 

 

 

 

 

225

 

 

 

 

 

227

 

231

 

 

232

 

 

 

 

233

 

 

 

452

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

453

 

 

 

 

 

454

 

455

 

 

465

 

 

 

 

LP

 

 

 

2 Year

 

 

1A

 

 

TRANSACTION TYPE

 

 

 

1B

 

PLATE TYPE

 

SCHOOL BUS (19)

 

 

 

 

 

 

 

 

 

 

 

VFW (52)

 

 

ATV (02)

 

 

 

 

 

MUNICIPAL (15)

PLATE #____________________

 

PLEASURE CAR (19)

 

CONSERVATION PLATE (48, 57)

 

 

 

 

 

US VET (49)

 

 

EMS (46)

 

 

 

 

 

FREEMASONS (54)

 

VANITY

 

 

 

 

 

BUILDING BRIGHT FUTURES (55)

 

 

 

 

 

NATIONAL GUARD (41)

 

VOLUNTEER (28)

 

 

 

ROTARY (53)

NEW (421)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISABLED PLATE

 

OFF-HWY TRACTOR (24)

 

 

 

 

 

 

 

 

 

PURPLE HEART (47)

 

 

FIREFIGHTER (40)

 

 

 

MOTOR BUS (04, 05)

TRANSFER (431)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRUCK (27)

 

 

 

 

 

AGRICULTURE (01) FARM USE ONLY

 

POW (23)

 

 

JITNEY/RENTAL (37)

 

 

 

STATE (22)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RENEW (475)

 

 

 

 

 

 

 

 

 

TRAILER (26, 25, 06)

 

SPECIAL PURPOSE TRK CAT I (11)

 

VIETNAM VET (50)

 

 

ANTIQUE (03) (AN)

 

 

 

STREET ROD (56)

REPLACEMENT PLATE

 

 

 

 

 

 

MOTORCYCLE (18)

 

SPECIAL PURPOSE TRK CAT II (20)

 

AMERICAN LEGION (38)

 

EXHIBITION (09) (EX)

 

 

 

FARM TRACTOR (45)

LOST STOLEN SEIZED

 

MOTOR HOME (19)

 

AMATEUR RADIO OPR (42)

 

 

 

 

 

 

 

 

SHERIFF (43)

 

 

LIONS CLUB (51)

 

 

 

Motor Driven Cycle (17)

IRP TAX & TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT CHANGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

MAKE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MODEL

 

 

 

 

 

 

 

 

 

 

MODEL YEAR

 

 

 

 

BODY TYPE

 

MILEAGE (NO TENTHS)

 

 

MILES

 

 

 

 

 

COLOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KM HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SERIAL NUMBER (VIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO OF CYL

 

 

 

 

 

 

 

VEHICLE IS

 

 

 

 

 

GAS

DIESEL HYBRID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW USED REBUILT

 

ELECTRIC

PROPANE

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3C

 

 

MOTORCYCLE

 

3D

 

 

 

 

 

 

 

 

 

 

 

 

TRUCKS (including Pick-Up & Farm)

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAILERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BUS/JITNEY/RENTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATV/MDC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY

 

 

 

 

 

 

 

 

 

 

 

LOADED

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY

 

 

 

 

 

 

 

LOADED WEIGHT

 

 

# Wheels

 

 

 

CC’s

EMPTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT

 

 

 

 

 

 

 

WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT

 

 

 

 

 

 

 

1500 or (26)

 

 

 

WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

# OF AXLES

 

 

BRAKE TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

LENGTH x WIDTH (FT)

 

 

 

 

 

 

 

 

 

 

 

 

# OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HYD

AIR OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1501 or (25)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOADED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEIGHT

 

 

 

 

 

 

 

 

 

 

4A

OWNER

VT DRIVER LICENSE NO

 

 

 

 

 

SSN or FEDERAL ID NUMBER

 

 

GENDER

 

CO-OWNER

 

 

 

VT DRIVER LICENSE NO

 

 

 

 

 

SSN or FEDERAL ID NUMBER

 

 

 

GENDER

 

LESSEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M F

 

LESSOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M F

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (PO Box or Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (PO Box or Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Address (Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Address (Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of birth

 

 

 

 

 

 

 

If name has changed, list previous name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of birth

 

 

 

 

 

 

 

 

 

If name has changed, list previous name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone Number & Email Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4B

 

 

 

 

 

 

 

 

 

 

 

 

 

MUST INDICATE RIGHTS OF SURVIVORSHIP (CHECK ONE BELOW) IF NO BOX IS CHECKED “JOINT TENANTS” WILL BE SELECTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouses

Joint Tenants

 

Tenants In Common

Partners (business)

 

 

TOD (Transfer on Death)

 

 

 

 

 

 

 

 

 

 

 

 

 

5A

 

Date of loan

 

 

 

 

 

 

 

 

VT license # (if individual)

 

 

 

Date of birth (if individual)

 

 

 

5B

 

Name of person/company vehicle acquired from

 

 

 

 

 

 

 

 

 

 

 

 

Date purchased

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lienholder Name

 

 

 

 

 

 

 

 

 

 

 

 

 

Lienholder Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of person/company vehicle acquired from

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of person/company (agent) vehicle acquired from

 

 

 

 

 

 

 

 

 

 

 

 

 

Dealer number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6A

 

Purchase Price

 

 

 

 

 

 

 

 

 

 

6B

 

Complete Section 6B to Claim Tax Credit or to Transfer Plates

 

 

9

 

 

 

 

 

 

DO NOT WRITE IN SHADED AREA

PURCHASE PRICE

 

 

$

 

 

 

 

 

 

 

 

 

 

PURCHASER OF OLD VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX CREDIT

 

 

$

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

 

 

 

ON (DATE)

 

 

 

 

 

 

 

Tax

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NET TAXABLE COST

$

 

 

 

 

 

 

 

 

 

 

YEAR

 

 

 

 

 

MAKE

 

 

 

 

 

 

PLATE

 

 

 

 

 

 

 

 

 

TAX EXEMPT #

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX (6%)

 

 

$

 

 

 

 

 

 

 

 

 

 

VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transfer

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

VERIFICATION OF VEHICLE IDENTIFICATION NUMBER - APPLICANT SHOULD NOT WRITE IN THIS SECTION

 

Warranty Fee

$5.00

 

12

 

NEW Vehicles Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE OF REG

 

Fuel User

 

 

 

 

 

 

31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

AT TOWN OR CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTHORIZED SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORGANIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Fees

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NCIC

 

 

VINASSIST

 

 

CERTIFICATE NUMBER

 

 

PHONE NUMBER

 

 

 

 

MILEAGE (NO TENTHS)

 

 

 

 

 

MILES KM HOURS

 

 

Return #

 

 

Rater #

 

 

 

RF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The owner certifies that this vehicle 1) is properly equipped and in good mechanical condition; 2) was

 

 

 

As the applicant for registration of a commercial motor vehicle, which is a motor vehicle with a gross

 

 

8

 

 

placed into use on or before the date this application was signed; 3) currently has liability insurance in

 

 

 

vehicle weight rating of 10,001 lbs. or more; is a vehicle that is used to transport hazardous materials; or

 

 

 

 

 

 

 

 

 

effect as required by 23 V.S.A. §800 (a).

 

If transfer of plates, the owner and/or this vehicle are not

 

 

 

is a vehicle that is designed to transport 16 or more passengers, including the driver, I hereby declare

 

 

 

 

under suspension pursuant to 23 V,S,A, §3009 (b) [diesel tax related]. Statements and warrants herein

 

 

 

that I have knowledge of the Federal Motor Carrier Safety Regulations, Title 49 of the Code of Federal

 

 

 

 

 

 

 

 

 

 

 

 

 

are certified under penalty of 23 V.S.A. §202, §203, §2082, and 32 V.S.A. §§ 8901-8915.

 

 

 

 

 

 

Regulations, as adopted by the State of Vermont.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE (OWNER/LESSEE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE (CO-OWNER/LESSOR)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1A

TRANSACTION TYPE: (New, Transfer or Renewal) Please indicate if this is a New Registration, Transfer or Renewal.

New

First time registration. New plates issued. May be Vermont or out-of-state vehicle. Complete the entire

 

 

application.

Transfer

For transfer of your Vermont registration from one vehicle to another, complete the entire application. Enter the

 

 

plate number that you are transferring. Fill out section 6B of this application. A change of legal ownership of your

 

 

previous vehicle must occur before a transfer will be allowed.

Renewal

For renewal complete Sections 1, 2, 4 and 8. Section 3, if applicable. Enter the plate number you are renewing.

Replacement

Indicate reason for replacement – Lost, Stolen or Seized by Law Enforcement.

 

 

$10.00 for all vehicles excluding state, municipal, fire department, and rescue organizations which are $7.00

IRP

Complete this form for Title and Purchase & Use Tax purposes. Special IRP Applications must also be completed.

 

 

For IRP forms and information call 802-828-2071. These transactions are only processed in the Montpelier office.

Weight Change

For changing the registered weight on a currently registered vehicle.

1B VEHICLE TYPE: Choose the one that best describes your vehicle registration. Additional Forms Required for the following plates

POW (23)

EMS (46)

LIONS CLUB (51)

FREE MASONS (54)

PURPLE HEART(47)

PEARL HARBOR (44)

VFW (52)

VANITY

DISABLED PLATE

AMATEUR RADIO OPR (42)

VIETNAM VETERANS (50)

NAT’L GUARD (41)

ROTARY (53)

FIRE FIGHTER (40)

US VETERANS (49)

AMERICAN LEGION (38)

 

 

 

 

2

Complete entire section for all types of vehicles

 

 

3A

Complete for Trucks including Pick Up Trucks, Agricultural Vehicles,

3B

Complete for Trailers

Cargo Vans, etc.

 

3C

Complete for Motorcycle, ATV & MDC

3D

Complete for Buses, Jitneys and/or Rental Vehicles

 

IF NO BOX IS CHECKED, JOINT TENANTS WILL BE SELECTED

 

TYPE OF OWNERSHIP

REQUIRED RELATIONSHIP

RIGHT OF SURVIVORSHIP

 

Spouses (Tenants By the Entirety)

Spouses

Yes

 

Joint Tenants

None

Yes

 

Tenants in Common

None

No

4

Partners

None

Yes

Transfer on Death*

None

Yes

 

Complete owner/co-owner information section. Enter physical address if mailing address is PO Box. If name change is indicated, documentation clearly stating the new name, must accompany this form. “Relationship to owner” is required information if the vehicle is registered and titled in more than one name. You must indicate your choice for rights of survivorship.

*Transfer on Death requires completion of separate form (Notification of Transfer on Death TA-VT-07) and is only applicable if vehicle is registered to only one owner.

5A

Complete if you have a loan on this vehicle. If Lien holder is an individual must include Vermont license number and Date of Birth. If

there is a second lien holder, send details.

 

The name and address of the seller and date purchased is information required for new and transfer Vermont registration, even if the

5B

vehicle has been registered and titled to you out-of-state. The signature of seller is required only for dealer transactions and non-titled

 

vehicles when there is no Bill of Sale.

Purchase and Use Tax is due at the time of registration and/or title at the rate of 6% (.06) of the purchase price or the average trade-in book value (NADA), whichever is greater, minus value of trade-in vehicle or any other allowable credit. If trade occurs out of state, proof of previous registration is required.

Autos/SUV’s/Antiques/Exhibits/Motor Homes or Motorcycles 6% of net taxable cost. No maximum tax. Trucks and Off-Highway

6A

Tractors registered at the 10,099 lb. weight or less, 6% of net taxable cost. No maximum tax. All other vehicles will be taxed at 6%

&of the net taxable cost - $1,850.00 maximum tax.

You may deduct the amount received from the sale of a vehicle last registered in your name, not to exceed the average book value

6B as shown in the Official Used Car Guide, N.A.D.A. (New England edition), provided such sale occurs within three months of the

taxable purchase

ATV’s are not subject to Purchase & Use Tax, but a Sales & Use Tax does apply. For ATV’s purchased from a dealer or a Vermont registered business you must submit proof of tax paid. For ATV’s purchased as a casual sale, no tax is due. If tax is due, form SU-452 must be completed and submitted.

A visual verification of the identification number (serial number) of your vehicle is required if the vehicle is required to be titled and:

 

Was last registered/titled in another state (unless purchased from

Has a Salvage Title, or

 

out of state dealer for the purpose of registering in VT), or

Is registered under bond, or

 

The vehicle is a motorcycle with an engine size of 300 cc’s or

Is imported from Canada without a Certificate of Origin or

 

more and last registered in another state, or

a new vehicle information statement, or

7

Is a non-titleable motorcycle with an engine size of 500 or more

The title documentation is from another country, or

 

cc’s unless proof of a previous VT registration is submitted, or

Has a U.S. Government Certificate of Release of Motor

 

 

Vehicle document.

Verifications completed outside of Vermont must be by motor vehicle officials, or by those personnel authorized by that state to perform VIN verifications. Military personnel may have VIN verifications conducted by the Commanding Officer or Provost Marshal of the military base. Verifications performed out of state must be accompanied by a letter of identification of the verifier on official letterhead.

8

Application must be signed and dated by owner(s). If signed by an authorized agent, proof of authorization, such as power of attorney,

etc. must be submitted. Owner signature certifies liability insurance is in effect for this vehicle pursuant to 23 V.S.A. §800(a).

 

TA-VD-119 50M 06/2013 MTC

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1. The Verifications usually requires particular information to be entered. Ensure that the subsequent blank fields are completed:

How you can complete VT part 1

2. Once the last segment is finished, it is time to put in the required particulars in Mailing Address PO Box or Street, Mailing Address PO Box or Street, City, State, ZIP, City, State, ZIP, Physical Address Street, Physical Address Street, City, State, ZIP, City, and State in order to proceed further.

A way to fill in VT stage 2

3. Within this stage, take a look at Year, TRANSACTION TYPE, PLATE NEW TRANSFER RENEW, B PLATE TYPE PLEASURE CAR, SCHOOL BUS CONSERVATION PLATE, VFW US VET NATIONAL GUARD, ATV EMS VOLUNTEER, MUNICIPAL FREEMASONS ROTARY, MAKE, SERIAL NUMBER VIN, MODEL, MODEL YEAR, BODY TYPE, MILEAGE NO TENTHS, and MILES KM HOURS. All these need to be filled out with utmost precision.

Learn how to complete VT portion 3

4. This next section requires some additional information. Ensure you complete all the necessary fields - City, State, ZIP, City, State, ZIP, Date of birth, If name has changed list previous, Date of birth, If name has changed list previous, Phone Number Email Address, Spouses Joint Tenants Tenants, VT license if individual, Date of birth if individual, and Name of personcompany vehicle - to proceed further in your process!

Filling out part 4 of VT

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