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The DMV VSA 17A form serves a critical function within the process of securing a title and registering various types of vehicles including passenger cars, motorcycles, trucks, motor homes, and trailers. Completing this form correctly ensures that vehicle ownership is established and documented officially. Individuals and businesses alike can use it to apply for a title, and there's even an option to request an electronic title. This can streamline the process for many, as it alleviates the need for paper documentation. When filling out the VSA 17A, applicants must provide vital information such as the full legal names of owners, contact details, and addresses, noting that a physical home or business address is required—no P.O. Box addresses are permitted. The form also prompts for details about the vehicle itself, including its year, make, model, and vehicle identification number (VIN). It is crucial for applicants to disclose any liens against the vehicle, as this impacts ownership and future transactions. Moreover, the VSA 17A includes sections to verify vehicle use and insurance status, which are key factors in compliance with state laws. For those looking to benefit from tax relief, proper completion of the personal property tax relief eligibility section is necessary. Overall, ensuring that every part of the DMV VSA 17A form is filled out accurately can prevent delays and facilitate a smoother title and registration process for all vehicle owners.

Dmv Vsa 17A Example

APPLICATION FOR

CERTIFICATE OF TITLE AND REGISTRATION

VSA 17A (07/01/2021)

PURPOSE: Use this form to apply for a title and/or to register a passenger vehicle, motorcycle, truck, motor home (RV), or trailer.

INSTRUCTIONS: Complete this form and return to any DMV customer service center (CSC). DMV may request proof of any information provided.

OWNER INFORMATION

 

APPLICATION TYPE:

 

 

Title

 

 

Electronic Title Option -- I want DMV to maintain an electronic certificate of

 

Check one:

 

 

 

 

 

Title and Registration (license plates issued)

title on file for this vehicle. (No paper title will be issued)

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check

 

 

Vehicle is owned by individual(s).

If this application is for joint ownership, do you wish clear rights of ownership to be transferred to

 

 

one:

 

 

 

Vehicle is business owned.

the surviving owner in the event of the death of either the owner or co-owner?

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S FULL LEGAL NAME (last, first, mi, suffix) OR BUSINESS NAME (if business owned)

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S FULL LEGAL NAME (last, first, mi, suffix)

 

 

 

TELEPHONE NUMBER

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Owners (and Lessees if applicable) MUST provide their residence/home/business address where requested, this

RESIDENCE/BUSINESS JURISDICTION

address can not be a P.O. Box. You must complete form ISD-01 if you would like your address(es) updated.

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S STREET ADDRESS (Apt # if applicable)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER'S MAILING ADDRESS (if different from above)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S STREET ADDRESS (Apt # if applicable)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-OWNER'S MAILING ADDRESS (if different from above)

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION WHERE VEHICLE IS PRINCIPALLY GARAGED

 

 

 

 

 

Are any of the owners/lessees on active

 

 

CITY

 

 

 

 

COUNTY

 

TOWN OF

 

 

 

 

 

military duty or service?

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF YOU WOULD LIKE YOUR REGISTRATION RENEWALS SENT TO AN ADDRESS OTHER THAN YOUR RESIDENCE/BUSINESS ADDRESS, ENTER IT BELOW.

 

 

 

 

REGISTRATION MAILING ADDRESS - OPTIONAL

 

CITY

 

 

 

 

 

STATE

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE INFORMATION

 

YEAR

 

MAKE

 

 

 

 

 

MODEL

 

 

 

 

 

BODY TYPE

 

 

 

 

VEHICLE IDENTIFICATION NUMBER (VIN)

 

 

 

 

 

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OF AXLES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPTY WEIGHT

GVWR (single vehicle weight - manufacturer)

GROSS WEIGHT (combined truck + attached trailer)

GCWR (combined weight: truck + attached trailer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FUEL

 

 

GAS

 

 

 

 

 

 

DIESEL

OTHER FUEL TYPE

 

 

 

VEHICLE

 

 

 

 

 

PRIMARY

 

IS THIS A LOW

 

 

YES

 

IS THIS A

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOGGING

 

 

 

 

 

 

TYPE

 

 

ELECTRIC

OTHER

 

 

 

 

 

 

 

 

 

 

COLOR

 

 

 

 

 

 

 

 

 

 

SPEED VEHICLE?

 

NO

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS VEHICLE STATE OR

 

 

YES - enter agency code

 

NO

DIVISION CODE

 

 

 

 

 

 

 

PREVIOUS TITLE NUMBER

 

 

 

 

 

 

STATE

 

 

 

 

 

 

 

LOCALITY-OWNED?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIEN INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IS THERE A LIEN ON THIS VEHICLE?

 

YES - YOU MUST COMPLETE THIS SECTION

 

 

 

NO - SKIP TO THE NEXT SECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF FIRST LIEN (mm/dd/yyyy)

LIENHOLDER NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIENHOLDER MAILING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For additional liens, complete VSA 66 and attach to this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOURCE OF OWNERSHIP INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW WAS THIS VEHICLE SOLD TO YOU?

 

 

 

PURCHASE DATE (mm/dd/yyyy)

RENTOR NUMBER

 

 

 

 

 

 

VA DEALER LICENSE NUMBER

 

 

(check one)

 

 

USED

 

NEW

 

DEMONSTRATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEALERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

SALES PRICE

 

 

 

PROCESSING FEE

SALES AND USE TAX

 

 

VEHICLE PURCHASED FROM

 

 

 

 

MANUFACTURER REBATE/INCENTIVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEASE INFORMATION (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESSEE'S FULL LEGAL NAME (last, first, mi, suffix)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

DMV CUSTOMER NUMBER / FEIN / SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESSEE'S RESIDENCE/BUSINESS ADDRESS

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ODOMETER STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ODOMETER READING (no tenths)

 

 

 

Federal and state laws require 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify to the best of my knowledge that: (check one)

 

 

The odometer reading above is the ACTUAL MILEAGE of the vehicle.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The odometer reading above is NOT the ACTUAL MILEAGE. (Odometer discrepancy.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The odometer reading above is IN EXCESS of its mechanical limits.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle was exempt from disclosure in prior state of title (applicant must present out-of-state title showing exemption)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOG NUMBER ____________________________________

TITLE NUMBER ____________________________________

 

VSA 17A (07/01/2021) Page 2

PERSONAL PROPERTY TAX RELIEF ELIGIBILITY

 

1. Answer the questions below to determine if your vehicle qualifies for car tax relief.

YES NO

a.Is more than 50% of the vehicle's annual mileage used as a business expense for federal income tax purposes OR reimbursed by an employer?

 

b.

Is more than 50% of the depreciation associated with the vehicle deducted as a business expense for federal income tax purposes?

 

c.

Is the cost of the vehicle expensed pursuant to Section 179 of the Internal Revenue Service Code?

 

2.

d.

If the vehicle is leased by an individual, does the leasing company pay the tax without reimbursement from the individual?

If you answered YES to ANY of the above questions, check Business Use. Your vehicle is considered by State law to have a business use and does NOT

 

qualify for Personal Property Tax Relief.

BUSINESS USE

 

3.

If you answered NO to ALL of the above questions, check Personal Use and answer the question below.

 

 

 

PERSONAL USE -- Is this vehicle held in a private trust for non-business purposes by an individual beneficiary?

YES NO

INSURANCE CERTIFICATION

I/We certify that (check one):

This vehicle is insured by a liability policy issued through an insurance company licensed to do business in Virginia and it will remain insured while registered, whether or not it is operated. Penalties are severe for violation of this requirement. Be advised that the amount of liability coverage required is higher for vehicles that are operated for hire.

NAME OF INSURANCE COMPANY

This vehicle is not insured; therefore, I am remitting the applicable uninsured motor vehicle fee. (This fee provides no insurance coverage.) A vehicle must be insured with liability coverage when it is registered, and it must remain insured while registered, whether or not it is operated, or the uninsured motor vehicle fee must be paid. Penalties are severe for violation of this requirement.

REGISTRATION INFORMATION

NOTE: Virginia offers more than 200 unique plates for our customers. Please visit www.dmvNow.com for a listing of special plates available. Not all plates are available for all vehicle types and some special plates require a certification form. Review our website for additional information.

 

REGISTRATION PERIOD (check one:)

 

ONE YEAR

 

 

 

 

 

 

 

 

 

 

TWO YEARS ($2 discount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THREE YEARS ($3 discount - not for emissions area)

 

 

TRANSFER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(enter plate number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION TYPE (check one:)

 

PRIVATE

 

 

 

 

RENTAL

 

 

 

FOR HIRE (complete For Hire Information below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trailer Permanent - (one time fee) select size:

 

Regular size plate

 

Small size plate (trailer gross weight must be 4,000 lbs or less)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION RECORD INDICATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Communication Needs Indicator - For

 

myself or

 

a person who regularly occupies this vehicle, I request a DMV record indicator for a disability

 

 

 

 

 

 

 

 

that can impair communication. The adult occupant, parent, legal guardian of an individual who regularly occupies the vehicle who has a communication

 

 

 

 

impairment authorizes and consents to the release of their communication impairment information to employees and agents of criminal justice agencies as

 

 

defined in Virginia Code § 9.1-101.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR HIRE INFORMATION

Check to indicate how the vehicle being registered will be used (check all that apply). If the vehicle will be used in property carrier operations, and those operations exclusively use passenger cars, motorcycles, autocycles, mopeds, or vehicles with a gross vehicle weight rating (GVWR) of 10,000 pounds or less, then registration for hire is not required.

 

 

 

PASSENGER CARRIER OPERATIONS

 

 

 

 

 

 

PROPERTY CARRIER OPERATIONS

 

 

 

 

 

 

 

 

 

 

Common Carrier - Regular Route

 

Employee Hauler

 

 

Sight-seeing Carrier

 

 

 

Property Carrier *

 

 

 

 

 

 

 

 

Common Carrier - Irregular Route

 

Contract Passenger Carrier

 

 

Non-Emergency Medical Transport

 

 

 

Household Goods Carrier *

 

 

 

 

 

 

 

 

 

Nonprofit/Tax-Exempt

 

Taxicab

 

 

Exempt Operations - Passengers *

 

 

 

Exempt Operations - Property *

 

 

 

 

 

 

 

*You must also complete the For-Hire Vehicles Registration Request (MCS115)

Do you hold a valid intrastate operating authority certificate/permit? YES NO

If no, and you are a passenger carrier you must also complete the For-Hire Vehicles Registration Request (MCS115).

NOTICE

PRIVACY NOTICE: The information, including Social Security Number, is requested in accordance with Virginia Code §§46.2-623 and 46.2-629. Any person who refuses to supply the required information will be denied a certificate of title and/or registration. By signing this form, you authorize DMV’s exchange of title and registration records with business, law enforcement, or government entities and you authorize DMV’s exchange of title and registration records in accordance with Va. Code §§46.2-208 through 46.2-214 and 18 U.S.C. 2721.

POWER OF ATTORNEY FOR NON-RESIDENT(S) AND CORPORATION(S) NOT DOMICILED IN VIRGINIA: Pursuant to the provisions of Virginia Code §46.2-601, I/we appoint the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, to be my/our true and legal agent upon whom all legal processes against me/us may be served in any legal proceeding arising from the operation and/or use of any motor vehicle registered in my/our name(s) in the Commonwealth of Virginia. I/we agree that any lawful process or notice to me/us which is served on the Commissioner shall have the same legal effect as if served on me/us within the Commonwealth of Virginia.

CERTIFICATION

I/We 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.

APPLICANT NAME (print)

SIGNATURE OF APPLICANT

DATE (mm/dd/yyyy)

 

 

 

CO-APPLICANT NAME (print)

SIGNATURE OF CO-APPLICANT

DATE (mm/dd/yyyy)

 

 

 

DMV USE ONLY

PROOF OF ADDRESS (specify proof document(s) presented)

WITH LIEN?

 

YES

 

NO

UMV FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES PRICE

$

TITLE FEE

$

IF HELD, REASON:

 

 

 

CSR STAMP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROCESSING FEE

$

TRANSFER FEE

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SALES & USE TAX

$

REGISTRATION FEE

$

TOTAL

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Get Dmv Vsa 17A PDF Form

Form Characteristics

Fact Name Details
Purpose of the Form This form is used to apply for a title and/or registration for vehicles such as passenger cars, motorcycles, trucks, motor homes, or trailers.
Submission Location Applicants must complete the form and submit it to any DMV customer service center (CSC) in Virginia.
Electronic Title Option Applicants can choose an electronic title option, which allows DMV to maintain an electronic certificate of title on file, avoiding the issuance of a paper title.
Joint Ownership Consideration The form addresses joint ownership, asking if rights should transfer to the surviving owner upon the death of an owner or co-owner.
Insurance Certification Requirement The applicant must certify that the vehicle is insured by a liability policy issued through a licensed company, or pay an uninsured motor vehicle fee.
Legal Authority This form is governed by Virginia Code §§46.2-623 and 46.2-629, which outline necessary information and procedures for vehicle registration and titling.

Guidelines on Utilizing Dmv Vsa 17A

Completing the DMV VSA 17A form can help you apply for vehicle title and registration. The following steps will guide you through the process of filling out the form accurately before submitting it at a DMV customer service center.

  1. Gather necessary documents, including proof of identity and existing vehicle titles if applicable.
  2. Begin by filling out the top section titled "Owner Information." Provide your full legal name or business name, telephone number, and DMV customer number, Social Security Number (SSN), or Federal Employer Identification Number (FEIN).
  3. If applicable, list the co-owner's details in the corresponding fields, including their name, contact number, and identification numbers.
  4. Complete the "Residence/Business Jurisdiction" section by providing the street address, city, state, and zip code. Ensure that this is not a P.O. Box. Fill out the "Mailing Address" if it differs from your residence.
  5. Identify the location where the vehicle will be principally garaged. Fill in the city, county, and town.
  6. Indicate if any owner is on active military duty by checking the corresponding box.
  7. Fill in the "Vehicle Information" section, providing details such as the year, make, model, body type, VIN, weight, fuel type, and any special classifications.
  8. In the "Lien Information" section, state whether there is a lien on the vehicle. If yes, include the lienholder's name and contact information.
  9. Specify how you acquired the vehicle in the "Source of Ownership Information" section. Indicate the purchase date, dealer license number, and sales price.
  10. Fill out the "Odometer Statement" accurately and select the statement that reflects the actual mileage of the vehicle.
  11. Answer the questions related to personal property tax relief eligibility. Based on your answers, check either "Business Use" or "Personal Use." Provide required details if your vehicle falls into personal use.
  12. Complete the "Insurance Certification" by affirming the vehicle's insurance status. Include the name of the insurance provider if insured.
  13. Select the registration information, including the desired registration period and type. Make sure to check for any applicable local requirements.
  14. If applicable, complete the "For-Hire Information" section, indicating the intended use of the vehicle and checking if you hold a valid operating authority permit.
  15. Sign and date the certification section at the end of the form to affirm the accuracy of the information provided.

Once you have completed the form, review all entries to ensure they are accurate. After confirming that the form is correctly filled out, submit it along with any required documents to a DMV customer service center. Keep a copy of the completed form for your records.

What You Should Know About This Form

What is the purpose of the DMV VSA 17A form?

The DMV VSA 17A form is used to apply for a title and/or register various types of vehicles, including passenger cars, motorcycles, trucks, motor homes (RVs), and trailers. Completing this form is essential for ensuring that your vehicle is legally recognized and can be driven on public roads.

How do I submit the VSA 17A form?

You can submit the completed VSA 17A form at any DMV customer service center. It's important to ensure that all required fields are filled out accurately. The DMV may contact you for additional proof or information related to your application.

Can I choose to have an electronic title instead of a paper title?

Yes, the form allows you to opt for an electronic title option. If you select this option, the DMV will maintain an electronic certificate of title for your vehicle, and no paper title will be issued. This option can be convenient as it reduces paperwork.

What information do I need to provide about the vehicle?

You'll need to provide specific details about your vehicle, including the year, make, model, vehicle identification number (VIN), body type, and gross weight. Additionally, if there are any liens on the vehicle, this information needs to be clearly stated.

What should I do if there is a lien on my vehicle?

If your vehicle has a lien, you must complete the lien information section on the form. This section requires details about the lienholder, including their name and mailing address. If there are multiple liens, you will need to attach an additional form, VSA 66, to your application.

What is the importance of the odometer statement?

The odometer statement is a crucial part of your application. Federal and state laws mandate that you provide the vehicle's mileage at the time of transfer. This is to ensure accuracy and prevent fraudulent claims. Misrepresentation of the odometer reading can result in serious penalties.

Do I have to provide proof of insurance?

Yes, you must certify that your vehicle is insured by a liability policy if you intend to register it. This insurance must be issued through a company licensed to operate in Virginia. Alternatively, if your vehicle is not insured, you will need to pay an uninsured motor vehicle fee, but this does not provide coverage.

How long is the registration valid, and how do I select the registration period?

You can select a registration period of one, two, or three years on the form. Notably, choosing a two-year registration grants a $2 discount, and a three-year registration offers a $3 discount (though this option is not available in emissions areas). This choice will affect the overall fees for your registration.

What happens if I provide false information on the form?

It's vital to ensure that all information on the VSA 17A form is accurate and truthful. Any false statements may lead to criminal charges and penalties. The DMV takes these matters seriously to maintain integrity in vehicle registration processes.

Common mistakes

Filling out the DMV VSA 17A form can be straightforward, but mistakes often occur. One common error is not providing the correct contact information. Applicants frequently skip including their telephone number or fail to include the correct area code. This can lead to delays or issues with processing the application.

Another mistake is related to the ownership section. Some people misunderstand the requirements for joint ownership. If the vehicle has multiple owners, it's essential to indicate how ownership rights will be transferred in the event of a co-owner’s death. Marking "YES" or "NO" without understanding the implications can create complications later.

A third area where errors often occur is the odometer statement. Applicants may either leave this section blank or provide incorrect readings. It is crucial to check one of the options concerning the odometer reading accurately. Failing to do so can result in fines because this information is legally required to be precise.

Finally, some people forget to confirm the vehicle's insurance status in the insurance certification section. Checking "This vehicle is not insured" without understanding the consequences can lead to significant penalties. It is important to ensure that the vehicle has adequate liability coverage in place before registration.

Documents used along the form

The DMV VSA 17A form is typically used for applying for vehicle titles and registrations in Virginia. However, several other documents may assist in this process or be required alongside the VSA 17A form. Here’s a brief overview of additional forms and documents you might need.

  • VSA 66: This form is used to report additional lien information when there are multiple liens on a vehicle. If your vehicle has had multiple loans, you'll need this to provide clarity on the lenders.
  • VSA 14: This is the Application for Certificate of Title when a vehicle is being registered for the first time. It's important for new purchases, especially if the vehicle is coming from out-of-state.
  • ISD-01: Use this form to update your address with the DMV. It's crucial if you've moved and want to ensure your information is accurate.
  • For-Hire Vehicles Registration Request (MCS115): If you plan to use the vehicle for hire, this form registers the vehicle as a for-hire unit.
  • Odometer Disclosure Statement: After buying or selling a vehicle, this document records the mileage. It ensures that the vehicle's history is clear and prevents fraud.
  • Power of Attorney (POA): If someone else will handle your vehicle registration or title transfer, a POA allows them to act on your behalf.
  • Insurance Documentation: Proof of insurance is mandatory when registering a vehicle. This document shows that your vehicle is covered legally.
  • Sales Tax Receipt: This receipt proves you've paid taxes on your vehicle purchase. You may need this when registering to satisfy tax obligations.
  • Vehicle Bill of Sale: This document serves as proof of purchase. It contains information about the transaction, ensuring all parties are in agreement.
  • Proof of Identity: A valid driver’s license or state-issued ID is necessary when submitting the VSA 17A form to verify your identity.

Each of these documents plays an important role in the vehicle title and registration process. Be sure to gather everything you might need to streamline your DMV visit and avoid any potential delays.

Similar forms

The DMV VSA 17A form is a crucial document for vehicle owners in Virginia, facilitating title applications and vehicle registrations. Several other forms serve similar purposes in different contexts or states. Below is a summary of five documents that share similarities with the VSA 17A form.

  • DMV VSA 66: This form is used to report additional liens on a vehicle. Like the VSA 17A, it requires detailed ownership information and is submitted to the DMV. It's essential for those applying for a title to clarify any existing financial claims on the vehicle.
  • DMV VSA 14: This "Application for a Duplicate Title" form is utilized when a title is lost or damaged. It requires you to provide similar personal and vehicle information as in the VSA 17A to verify ownership and process the title replacement.
  • DMV VSA 10: For out-of-state vehicles, this form acts as an "Application for Title and Registration." It similarly collects owner details, vehicle specifics, and safeguards the DMV's verification process for vehicles coming from other states.
  • DMV VSA 66A: Known as the "Application for a Non-Title Registration," this form is for vehicles that either do not have a title or are not eligible for title. It captures the owner information and vehicle details in a manner consistent with the VSA 17A.
  • DMV Form 893: This is a "Statement of Origin" used by manufacturers for new vehicles. It provides information about the manufacturer and is similar in that it documents ownership transition, which is also emphasized in the VSA 17A during title and registration processes.

Understanding these forms is essential for ensuring proper filing and compliance with DMV regulations. Each serves to affirm ownership and clarify the legal standing of vehicles on the road.

Dos and Don'ts

When filling out the DMV VSA 17A form, it’s important to keep certain guidelines in mind. This ensures your application is processed smoothly. Here’s a helpful list of things you should and shouldn’t do:

  • Do: Fill out the form completely and accurately. Missing information can delay processing.
  • Do: Use your full legal name and provide current contact information.
  • Do: Provide your residential or business address, as required.
  • Do: Check all applicable boxes to indicate ownership and registration preferences.
  • Do: Sign and date the form at the end. Without a signature, your application may be rejected.
  • Don’t: Use a P.O. Box for your address. A physical address is required.
  • Don’t: Submit false information. This can lead to penalties or denial of your application.
  • Don’t: Leave sections blank, especially if they are required. This may result in additional processing time.
  • Don’t: Forget to include any required supporting documents. Failure to provide necessary papers can delay your application.

By following these guidelines, you can help ensure a smoother experience with the DMV.

Misconceptions

Multiple misconceptions surround the DMV VSA 17A form, which is utilized for applying for a certificate of title and vehicle registration in Virginia. Below are five prevalent misunderstandings:

  • It Can Be Filled Out with a P.O. Box Address: Many believe that using a P.O. Box for the vehicle owner's address is acceptable. However, the form clearly states that the provided address cannot be a P.O. Box, as it must reflect the true residential or business location.
  • Only New Vehicles Require This Form: Some individuals think that this form is solely for new vehicle purchases. In reality, the VSA 17A form is required for a variety of transactions including used vehicles, motorcycles, trailers, and more.
  • The Form Does Not Need to Be Notarized: A common myth is that the application must be notarized for it to be valid. Notarization is not required for the VSA 17A; the applicant must simply sign to certify the accuracy of the information provided.
  • Any Address Can Be Used for Registration Renewals: There is a belief that registration renewals can be sent to any address. However, if the applicant desires the renewals sent to a different address, it must be explicitly indicated on the form; otherwise, the defaults to the registered address apply.
  • Failure to Complete the Odometer Statement Leads to Minor Issues: Some applicants underestimate the importance of completing the odometer statement. In fact, failing to provide accurate mileage information can result in serious penalties including fines and potential imprisonment.

Key takeaways

  • Purpose of the Form: The DMV VSA 17A form is essential for applying for a title and/or registering various vehicles, including passenger cars, motorcycles, and even trailers.

  • Information Requirements: Complete personal and vehicle details are crucial. This includes the owner's legal name, the vehicle's make and model, and all relevant identification numbers.

  • Residency Information: Owners must provide their residential address. A P.O. Box is not acceptable; this restriction also applies to joint ownership situations.

  • Joint Ownership Considerations: If applying for joint ownership, you have the option to specify rights of ownership transfer in the event of one owner's death.

  • Insurance Certification: You must certify whether the vehicle is insured or if you are opting to pay the uninsured motor vehicle fee. Proper liability coverage is a legal requirement.

  • Special License Plates: Virginia offers a variety of special plates. Be sure to visit the DMV website for a complete list of options, as not all vehicle types are eligible for every plate.

  • Certification of Accuracy: At the end of the form, you must certify that the information provided is true and accurate. This statement holds legal weight, underscoring the importance of honesty in your application.

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