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Form Ta Vd 119 PDF Details

Form Ta Vd 119 helps businesses collect and manage information about their customers. By understanding how your customers interact with your business, you can improve your customer service and marketing efforts. This form is used to gather contact information, account numbers, purchase history, and other related data. Completing this form accurately will help you get the most out of your customer relationships.

Question	Answer
Form Name	Form Ta Vd 119
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	TRK, 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

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

TRUCKS (including Pick-Up & Farm)

TRAILERS

ATV/MDCMOTORCYCLE

3D BUS/JITNEY/RENTAL

EMPTY

LOADED

EMPTY

LOADED WEIGHT

# Wheels

CC’s

EMPTY

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)

City:

State:

ZIP:

City:

State:

ZIP:

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
	4B		 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

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

TAX CREDIT

CITY

STATE

ON (DATE)

Tax

NET TAXABLE COST

YEAR

MAKE

PLATE

TAX EXEMPT #

Title

TAX (6%)

VIN

Transfer

7	VERIFICATION OF VEHICLE IDENTIFICATION NUMBER - APPLICANT SHOULD NOT WRITE IN THIS SECTION	Warranty Fee	$5.00	12	NEW Vehicles Only
				12	NEW Vehicles Only

DATE		AT TOWN OR CITY		STATE	Other
					Other
AUTHORIZED SIGNATURE			ORGANIZATION		Total Fees
					Total Fees
NCIC	VINASSIST	CERTIFICATE NUMBER	PHONE NUMBER	MILEAGE (NO TENTHS)	฀MILES ฀KM ฀HOURS	Return #	Rater #	RF
NCIC	VINASSIST	CERTIFICATE NUMBER	PHONE NUMBER	MILEAGE (NO TENTHS)	฀MILES ฀KM ฀HOURS	Return #
 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

TRANSACTION TYPE

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

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

MOTORCYCLE

TRUCKS (including Pick-Up & Farm)

TRAILERS

BUS/JITNEY/RENTAL

ATV/MDC

EMPTY

LOADED

EMPTY

LOADED WEIGHT

# Wheels

CC’s

EMPTY

WEIGHT

 1500 or  (26)

WEIGHT

# OF AXLES

BRAKE TYPE

LENGTH x WIDTH (FT)

# OF

 HYD

 AIR  OTHER

 1501 or  (25)

PASSENGERS

LOADED

WEIGHT

 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

Mailing Address (PO Box or Street)

City:

State:

ZIP:

City:

State:

ZIP:

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:

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

Lienholder Name

Lienholder Address

Address of person/company vehicle acquired from

City

State

Zip

Signature of person/company (agent) vehicle acquired from

Dealer number

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

TAX CREDIT

CITY

STATE

ON (DATE)

Tax

NET TAXABLE COST

YEAR

MAKE

PLATE

TAX EXEMPT #

Title

TAX (6%)

VIN

Transfer

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

Warranty Fee

$5.00

NEW Vehicles Only

VEHICLE IDENTIFICATION NUMBER

STATE OF REG

Fuel User

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 #

 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

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)

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.		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
4	Transfer on Death*	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
5A	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,
	8	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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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.

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.

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!

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VEHICLE IDENTIFICATION NUMBER

STATE OF REG