Vsa 56 Form Dmv – Fill Out and Use This PDF

Under OWNER INFORMATION, enter the OWNER FULL LEGAL NAME as last, first, middle and suffix, then the SSN, FEIN OR VA DRIVER'S LICENSE NUMBER, the TELEPHONE NUMBER, the DEALER/REBUILDER NUMBER and the OWNER STREET ADDRESS with CITY, STATE and ZIP CODE.

If there is a co-owner, enter the CO-OWNER FULL LEGAL NAME as last, first, middle and suffix, then the SSN, FEIN OR VA DRIVER'S LICENSE NUMBER and the EMAIL ADDRESS.

Under LIEN INFORMATION: Is there a lien on this vehicle? YES - Complete this section. NO - Go to SOURCE INFORMATION section.

In the lien section, enter the LIEN DATE (mm/dd/yyyy), the LIENHOLDER NAME and the LIENHOLDER MAILING ADDRESS with ZIP CODE, CITY and STATE.

Under SOURCE INFORMATION, enter the VEHICLE PURCHASED FROM with its STREET ADDRESS, CITY, STATE and ZIP CODE, then the SALE PRICE, the SALES AND USE TAX and the PURCHASE DATE (mm/dd/yyyy).

Enter the CURRENT TITLE ISSUE DATE (mm/dd/yyyy), the CURRENT TITLE NUMBER and the STATE.

Under VEHICLE INFORMATION, check the box CITY, COUNTY or TOWN of and enter the name of the city, county or town where the vehicle is principally garaged.

Enter the vehicle identification number, year, make, model, body type, the vehicle color as primary and secondary, then the empty weight, gross weight, number of axles and fuel type.

Enter the ACTUAL CASH VALUE (if required), the ESTIMATED REPAIRS COST (if required), the PERCENT OF DAMAGE (if required) and the VEHICLE ACQUIRED DATE (mm/dd/yyyy).

Enter the INSURANCE COMPANY NAME, the INSURANCE CODE NUMBER, the INSURANCE CLAIM NUMBER and the CLAIM PAYMENT DATE (mm/dd/yyyy).

Check WATER DAMAGE CLAIM OF $3,500 OR MORE HAS BEEN PAID BY THE INSURANCE COMPANY or STOLEN VEHICLE (checked November 2, 2026).

Enter the 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. Statement one: The mileage stated is in excess of its mechanical limits. Statement two: The model year is at least 10 years or older than the current calendar year and was exempt from odometer disclosure in the prior state of title (Applicant must present the out-of-state title showing the exemption). Statement three: The odometer reading is not the actual mileage.

Under PARTS REPAIRED/REPLACED (Required), check REPAIRED or REPLACED for each part listed, then list other damaged parts and SPECIFY REPAIRS.

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

The SALVAGE EXAM EXEMPTION 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 (checked November 2, 2026). All of these conditions must be met in order to obtain a rebuilt title without an examination.

Complete the following for each license type you currently possess: the Business Type (Salvage Dealer, Rebulider, Demolisher, Auto Recycler, Scrap Metal Processor, Salvage Pool or Vehicle Removal Processor), its License Number and its Established Date (mm/dd/yyyy).

Enter the Rebuilt Vehicle Resale Value.

Any person who refuses to supply the required information will be denied a salvage certificate.

Under CERTIFICATION, the applicant makes application for a Salvage Certificate for the vehicle described herein and certifies and affirms that all information presented in this form is true and correct, that any documents presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. The certification and affirmation are under penalty of perjury, and knowingly making a false statement or representation on this form is a criminal violation.

Each applicant signs on a SIGNATURE OF APPLICANT line and enters the DATE (mm/dd/yyyy).

All owners must sign.

Submit the completed application with the estimated cost of repairs to the Vehicle Branding Work Center.

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.