Vsa 56 Form Dmv PDF Details

Navigating the complexities of vehicle recovery and registration after an unfortunate event leading to salvage can be a daunting process. The VSA 56 DMV form, an essential document for such instances, facilitates this by serving a dual purpose: to apply for a salvage certificate and to report substantial water damage to a vehicle. A painstakingly detailed application, it requires comprehensive information from the vehicle's owner, including legal name, contact details, and specifics about the lien on the vehicle, if applicable. Further intricacies involve the vehicle's purchase and insurance claim details, alongside a precise account of the damage incurred, categorized by the extent and type of repairs needed. Additionally, the form delves into the precise estimation of repair costs and the vehicle's condition, crucial for accurately assessing its salvage status. Establishing eligibility for a salvage exemption is another vital aspect covered, applicable under certain conditions to bypass the need for a salvage examination. This intricate procedure underscores the necessity for complete and accurate disclosure to ensure compliance with federal and state laws, underscored by a stern warning against the provision of false information, which carries legal penalties. Thus, the VSA 56 form stands as a comprehensive tool, guiding vehicle owners through the salvage certification process, ensuring that all necessary legal and procedural boxes are checked, facilitating a smoother transition towards vehicle recovery or salvage.

QuestionAnswer
Form NameVsa 56 Form Dmv
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvsa56, vsa certificate application, virginia salvage certificate, dmv form vsa 56

Form Preview Example

SALVAGE CERTIFICATE APPLICATION

VSA 56 (07/01/2020)

 

Purpose: Use this form to apply for a salvage certificate and/or to report water damage to a vehicle.

Instructions: Submit the completed application with the estimated cost of repairs to the Vehicle Branding Work Center at the above address.

OWNER INFORMATION

OWNER FULL LEGAL NAME (last)

(first)

(middle)

(suffix)

 

 

 

SSN, FEIN OR VA DRIVER'S LICENSE NUMBER

TELEPHONE NUMBER

DEALER/REBUILDER NUMBER

 

 

 

 

OWNER STREET ADDRESS

CITY

STATE

ZIP CODE

 

 

 

 

CO-OWNER FULL LEGAL NAME (last)

(first)

(middle)

(suffix)

 

 

 

 

SSN, FEIN OR VA DRIVER'S LICENSE NUMBER

EMAIL ADDRESS

 

 

 

 

 

 

LIEN INFORMATION

Is there a lien on

 

YES - Complete this section.

LIEN DATE (mm/dd/yyyy)

LIENHOLDER NAME

 

 

 

 

 

 

 

 

this vehicle?

 

NO - Go to SOURCE INFORMATION section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

SOURCE INFORMATION

VEHICLE PURCHASED FROM

SALE PRICE

SALES AND USE TAX

PURCHASE DATE (mm/dd/yyyy)

 

 

 

 

 

 

STREET ADDRESS

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

CURRENT TITLE ISSUE DATE (mm/dd/yyyy)

 

CURRENT TITLE NUMBER

STATE

 

 

 

 

 

 

 

VEHICLE INFORMATION

Check box and enter name of city, county or town where vehicle is principally garaged.

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTY

 

TOWN of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YEAR

 

 

 

 

 

MAKE

 

 

 

 

 

MODEL

 

 

 

BODY TYPE

 

 

 

VEHICLE COLOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIMARY

SECONDARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY WEIGHT

 

GROSS WEIGHT

 

 

 

 

 

NUMBER OF AXLES

 

 

FUEL TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTUAL CASH VALUE (if required)

 

ESTIMATED REPAIRS COST (if required)

PERCENT OF DAMAGE (if required)

VEHICLE ACQUIRED DATE (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE COMPANY NAME

 

 

 

 

 

 

 

INSURANCE CODE NUMBER

INSURANCE CLAIM NUMBER

CLAIM PAYMENT DATE (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WATER DAMAGE CLAIM OF $3,500 OR MORE HAS BEEN PAID BY THE INSURANCE COMPANY

 

 

STOLEN VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ODOMETER READING

 

 

 

 

 

ODOMETER READING (no tenths)

 

 

 

 

 

Federal and state law requires that you state the mileage in connection with the transfer of ownership. Failure to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

complete the statement or providing a false statement may result in fines and/or imprisonment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To the best of my knowledge the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked:

 

 

 

 

 

 

The mileage stated is in excess of its mechanical limits.

 

 

The model year is at least 10 years or older than the current calendar year and was

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The odometer reading is not the actual mileage.

 

 

exempt from odometer disclosure in the prior state of title. (Applicant must present the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

out-of-state title showing the exemption).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DMV USE ONLY

 

 

 

 

 

REASON HELD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALE PRICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NCIC CHECK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TITLE FEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITH LIEN

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VSA 56 (07/01/2020)

 

 

 

 

 

 

 

 

PARTS REPAIRED/REPLACED (Required)

 

 

 

 

Page 2

REPAIRED REPLACED

REPAIRED REPLACED

REPAIRED REPLACED

REPAIRED REPLACED

 

 

 

 

 

Front Bumper

 

 

 

 

Left Front Door

 

 

 

 

Trunk

 

 

 

 

Air Bags

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Grill

 

 

 

 

Right Front Door

 

 

 

 

Rear Bumper

 

 

 

 

Dash

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hood

 

 

 

 

Left Rear Door

 

 

 

 

Roof

 

 

 

 

Dash Pad

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Radiator Support

 

 

 

 

Right Rear Door

 

 

 

 

Engine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Left Fender

 

 

 

 

Left Rear Quarter Panel

 

 

 

 

Transmission

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right Fender

 

 

 

 

Right Rear Quarter Panel

 

 

 

 

Frame/Unibody

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

damaged parts:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Damaged

SPECIFY REPAIRS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or Not Listed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you have replaced a Pickup Cab or Frame, vehicle is reconstructed and may need to be assigned a new Vehicle Identification Number.

SALVAGE EXAM EXEMPTION

This section must be completed when applying for a rebuilt certificate of title without an examination. An examination is not required for applicants who meet the following conditions:

•The person rebuilding the vehicle has been licensed under chapter (46.2-1605) for at least 10 years and has not had any penalties pursuant to the provisions of this chapter

•The rebuilt vehicle is at least 10 years old but does not qualify as an antique motor vehicle

•The resale value is less than $10,000

All of the above conditions must be met in order to obtain a rebuilt title without an examination. Please complete the following for each license type you currently possess.

Business Type

License Number

Established Date (mm/dd/yyyy)

Salvage Dealer

Rebulider

Demolisher

Auto Recycler

Scrap Metal Processor

Salvage Pool

Vehicle Removal Processor

Rebuilt Vehicle Resale Value:

ADDITIONAL INFORMATION

The information requested on an application for salvage certificate, in accordance with Virginia Code § 46.2-1603 (salvage certificate), as amended, is subject to dissemination to authorized agencies or individuals. Any person who refuses to supply the required information will be denied a salvage certificate. All salvage certificate records in the office of the Department of Motor Vehicles are privileged records subject to such regulations as the Commissioner may adopt. Copies of administrative rules and regulations are available from the Department of Motor Vehicles, Post Office Box 27412, Richmond, Virginia 23269-0001. This information is furnished to you in compliance with Virginia Code § 2.2-3806.

CERTIFICATION

All owners must sign. Giving misinformation with fraudulent intent is punishable as provided by law. Any person who falsely states the selling price or evades payment of tax shall be guilty of a Class 3 misdemeanor.

I/We hereby make application for a Salvage Certificate for the vehicle described herein and I/we further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I/we make this certification and affirmation under penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation.

SIGNATURE OF APPLICANT

DATE (mm/dd/yyyy)

SIGNATURE OF APPLICANT

DATE (mm/dd/yyyy)

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It's straightforward to complete the form with this helpful tutorial! Here is what you must do:

1. The virginia salvage certificate form involves particular information to be inserted. Be sure that the following blanks are complete:

Filling in segment 1 in vsa certificate application

2. Right after filling out the last part, head on to the subsequent stage and fill out the necessary details in all these blanks - YEAR, MAKE, MODEL, BODY TYPE, VEHICLE COLOR, PRIMARY, SECONDARY, EMPTY WEIGHT, GROSS WEIGHT, NUMBER OF AXLES, FUEL TYPE, ACTUAL CASH VALUE if required, ESTIMATED REPAIRS COST if required, PERCENT OF DAMAGE if required, and VEHICLE ACQUIRED DATE mmddyyyy.

Step number 2 in filling out vsa certificate application

3. Completing REPAIRED REPLACED, REPAIRED REPLACED, REPAIRED REPLACED REPAIRED REPLACED, Front Bumper, Grill, Hood, Radiator Support, Left Fender, Right Fender, Left Front Door, Right Front Door, Left Rear Door, Right Rear Door, Left Rear Quarter Panel, and Right Rear Quarter Panel is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Step no. 3 for submitting vsa certificate application

4. To move onward, this section will require filling in a couple of fields. These include Salvage Dealer, Rebulider, Demolisher, Auto Recycler, Scrap Metal Processor, Salvage Pool, Vehicle Removal Processor, Rebuilt Vehicle Resale Value, ADDITIONAL INFORMATION, The information requested on an, and CERTIFICATION, which you'll find fundamental to continuing with this particular form.

Part # 4 for completing vsa certificate application

5. To wrap up your document, the last subsection features a few additional blank fields. Entering IWe hereby make application for a, SIGNATURE OF APPLICANT, SIGNATURE OF APPLICANT, DATE mmddyyyy, and DATE mmddyyyy is going to finalize everything and you'll certainly be done very quickly!

Step number 5 in filling out vsa certificate application

Regarding DATE mmddyyyy and IWe hereby make application for a, make sure you get them right in this section. These two are definitely the most important ones in the PDF.

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