Vsa 66 Form PDF Details

If you are a veteran or the dependent of a veteran, you may be eligible for benefits through the Veterans Service Agency (VSA). The VSA 66 form is your application for these benefits. In order to qualify, you must provide proof of your military service and meet certain other requirements. This guide will help you understand the process and complete the VSA 66 form accurately.

This general report will help you establish the time it will require you to complete vsa 66 form, how many pages it has, and a handful of additional specific details about the PDF.

QuestionAnswer
Form NameVsa 66 Form
Form Length2 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out42 sec
Other namesva dmv form vsa 67, vsa 66, virginia dmv vsa 66, how to virginia replacement titles

Form Preview Example

APPLICATION FOR

VSA 66 (12/20/2016)

TRANSFER AND SUPPLEMENTAL LIENS

Purpose: Use this form to apply for a lien transfer or a supplemental lien.

Instructions: Submit this form to any DMV customer service center with the appropriate fees. You may also mail the form and fees to the Titling Work Center at the address above.

APPLICATION TYPE

CHECK ONE:

Transfer of Lien: Submit an original title unless the lienholder is a participant in the electronic title program. Complete sections

(1) Owner Information, (2) Vehicle Information, (3) Current Lien Information, (4) Transfer of Lien, and (6) Certification.

Supplemental Lien: Submit an original title unless the new lienholder is the same as the old lienholder and the lienholder is a participant in the electronic title program. Complete sections (1) Owner Information, (2) Vehicle Information, (3) Current Lien Information, (5) Supplemental Lien, and (6) Certification.

1. OWNER INFORMATION

OWNER FULL LEGAL NAME (last, first, middle, suffix)

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

CO-OWNER FULL LEGAL NAME (last, first, middle, suffix)

 

 

 

 

 

 

 

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

MAILING ADDRESS

 

 

 

CITY OR TOWN

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are any of the vehicle owners on active military duty or service?

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. VEHICLE INFORMATION

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER (VIN)

TITLE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

PLATE NUMBER

PLATE TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YEAR

 

MAKE

MODEL

 

 

 

 

 

 

 

 

 

 

 

BODY TYPE

 

 

 

 

WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. CURRENT LIEN INFORMATION

 

 

 

 

 

 

 

Check One:

 

 

 

Printed original paper title certificate attached

 

 

 

 

Original title certificate is electronic title (no paper title attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER NAME

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

 

LIEN DATE (mm/dd/yyyy)

FIRST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIEN

 

LIENHOLDER MAILING ADDRESS

 

 

CITY OR TOWN

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER NAME

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

 

LIEN DATE (mm/dd/yyyy)

SECOND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIEN

 

LIENHOLDER MAILING ADDRESS

 

 

CITY OR TOWN

 

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. TRANSFER OF LIEN

 

 

 

 

 

 

 

Complete this section only to transfer a lien to a new lienholder.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW LIENHOLDER NAME

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

DATE OF LIEN FILING (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS

 

CITY OR TOWN

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. SUPPLEMENTAL LIEN

Complete this section to add a lien. The priority of the security interest will be determined according to the date of the application filing (Virginia Code § 46.2-637).

LIENHOLDER NAME

 

LIENHOLDER CODE

DATE OF LIEN FILING (mm/dd/yyyy)

 

 

 

 

 

MAILING ADDRESS

CITY OR TOWN

STATE

ZIP CODE

 

 

 

 

 

LOG NUMBER __________________________ TITLE NUMBER _________________________________

VSA 66 (12/20/2016)

Page 2

6. CERTIFICATION

I/we hereby make application for a title certificate for the vehicle described herein and for that purpose 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.

Owners must sign when application is made for a supplemental lien. Lienholders must sign when transferring a lien.

OWNER SIGNATURE

DATE (mm/dd/yyyy)

CO-OWNER SIGNATURE

DATE (mm/dd/yyyy)

CURRENT LIENHOLDER NAME (print)

CURRENT LIENHOLDER SIGNATURE

DATE (mm/dd/yyyy)

NEW LIEN HOLDER NAME (print)

NEW LIENHOLDER SIGNATURE

DATE (mm/dd/yyyy)

PRIVACY ACT NOTICE

The information, including Social Security Number, is requested in accordance with §46.2-623 (Virginia Code). Any person who refuses to supply the required information will be denied a Certificate of Title and/or registration. Title and registration records may be disseminated in accordance with Virginia Code §§ 46.2- 208 through 46.2-214, to business, law enforcement, or authorized government entities.

How to Edit Vsa 66 Form Online for Free

Managing files along with our PDF editor is easier as compared to most things. To change virginia dmv vsa 66 the form, there's nothing you should do - merely continue with the steps down below:

Step 1: Press the button "Get form here" to get into it.

Step 2: At the time you get into our virginia dmv vsa 66 editing page, you'll see all of the options it is possible to take with regards to your form in the top menu.

The next sections will make up the PDF file that you will be creating:

completing dmv 66 vsa form part 1

Type in the required details in the section Check One, Printed original paper title, Original title certificate is, LIENHOLDER NAME, LIENHOLDER CODE, LIEN DATE mmddyyyy, CURRENT LIEN INFORMATION, FIRST LIEN, SECOND LIEN, LIENHOLDER MAILING ADDRESS, CITY OR TOWN, STATE, ZIP CODE, LIENHOLDER NAME, and LIENHOLDER CODE.

dmv 66 vsa form Check One, Printed original paper title, Original title certificate is, LIENHOLDER NAME, LIENHOLDER CODE, LIEN DATE mmddyyyy, CURRENT LIEN INFORMATION, FIRST LIEN, SECOND LIEN, LIENHOLDER MAILING ADDRESS, CITY OR TOWN, STATE, ZIP CODE, LIENHOLDER NAME, and LIENHOLDER CODE fields to complete

You can be requested to write down the particulars to let the system fill out the box Complete this section to add a, LIENHOLDER CODE, DATE OF LIEN FILING mmddyyyy, MAILING ADDRESS, CITY OR TOWN, STATE, and ZIP CODE.

step 3 to entering details in dmv 66 vsa form

As part of paragraph OWNER SIGNATURE, COOWNER SIGNATURE, CURRENT LIENHOLDER NAME print, CURRENT LIENHOLDER SIGNATURE, NEW LIEN HOLDER NAME print, NEW LIENHOLDER SIGNATURE, DATE mmddyyyy, DATE mmddyyyy, DATE mmddyyyy, DATE mmddyyyy, The information including Social, and PRIVACY ACT NOTICE, identify the rights and responsibilities.

Filling out dmv 66 vsa form stage 4

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