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Vehicle Registration Application VSA 14 - Virginia

Vehicle Registration Application Form. This is a Virginia form and can be used in Department Of Motor Vehicles Statewide .
 Fillable pdf Last Modified 8/31/2012
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VEHICLE REGISTRATION APPLICATION VSA 14 (7/01/2012) Purpose: Use this form to apply for registration of your vehicle. Note: You must obtain a Virginia vehicle safety inspection sticker and pay any required local vehicle registration fees to your city or county. For the City of Virginia Beach only, DMV collects local vehicle registration fees. Instructions: Refer to the Registration Information Sheet (VSA 14I) for general registration information. All owners must sign the Certification/Signatures section. Mail completed form with a check or money order (made payable to DMV) to the Titling Work Center at the above address, or present to any DMV Customer Service Center (CSC) or DMV Select. Note: A $5 service fee per vehicle applies to each renewal transaction conducted in a CSC, unless the renewal is conducted with another transaction that cannot be completed by internet, automated telephone, mail or at a DMV Select. REGISTRATION INFORMATION Registration Period: (check one) Registration Type: (check one) Reissue (Decals Only) One Year Original Rental Vehicle Two Years ($2 discount applies) Renewal Private ENTER PLATE NUM Reissue (Plates & Decals) See Reissue Plates below under Plate Information. Transfer License Plate Number: For Hire (complete "For Hire Information" section) Amateur Radio Operator Call Letters* -- Specify letters: * Vehicle must be equipped according to Virginia law. Ridesharing (Vanpool) (Cannot exceed 16 passengers including driver.) Seating Capacity Other: SPECIFY OWNER INFORMATION OWNER'S FULL LEGAL NAME (last, first, mi, suffix) OR BUSINESS NAME (if business owned) CO-OWNER'S FULL LEGAL NAME (last, first, mi, suffix) TELEPHONE NUMBER TELEPHONE NUMBER DMV CUSTOMER NUMBER / FEIN / SSN DMV CUSTOMER NUMBER / FEIN / SSN NOTE: Owners (and Lessees if applicable) MUST provide their residence/home/business address where requested, this address RESIDENCE/BUSINESS JURISDICTION can not be a P.O. Box. You must complete form ISD-01 if you would like your address(es) updated. OWNER'S RESIDENCE/HOME/BUSINESS ADDRESS (Apt # if applicable) CO-OWNER'S RESIDENCE/HOME/BUSINESS ADDRESS (Apt # if applicable) OWNER EMAIL ADDRESS CITY CITY CO-OWNER EMAIL ADDRESS STATE STATE ZIP CODE ZIP CODE ADDITIONAL INFORMATION LOCATION WHERE VEHICLE IS PRINCIPALLY GARAGED CITY COUNTY TOWN OF REGISTRATION MAILING ADDRESS - OPTIONAL IF NEW LOCATION ENTER DATE CHANGED Are any of the owners/lessees on active military duty or service? CITY STATE YES ZIP CODE NO IF YOU WOULD LIKE YOUR REGISTRATION RENEWALS SENT TO AN ADDRESS OTHER THAN YOUR RESIDENCE/BUSINESS ADDRESS, ENTER IT BELOW. LEASE INFORMATION (if applicable) LESSEE'S FULL LEGAL NAME (last, first, mi, suffix) LESSEE'S RESIDENCE/BUSINESS ADDRESS CITY TELEPHONE NUMBER DMV CUSTOMER NUMBER / FEIN / SSN STATE ZIP CODE VEHICLE INFORMATION TITLE NUMBER YEAR MAKE GROSS WEIGHT VEHICLE IDENTIFICATION NUMBER (VIN) MODEL GROSS VEHICLE WEIGHT RATING GVWR BODY TYPE CURRENT PLATE NUMBER AXLES FUEL EXPIRATION DATE (mm/dd/yyyy) SEATING CAPACITY (including driver) VEHICLE COLOR PRIMARY SECONDARY EMPTY WEIGHT GROSS COMBINATION WEIGHT RATING GCWR FOR HIRE INFORMATION Check to indicate how the vehicle being registered will be used. (check all that apply) PASSENGER CARRIER OPERATIONS PROPERTY CARRIER OPERATIONS Common Carrier - Regular Route Employee Hauler Sight-seeing Carrier Common Carrier - Irregular Route Contract Passenger Carrier Non-Emergency Medical Transport Nonprofit/Tax-Exempt Taxicab Exempt Operations - Passengers * * You must also complete the For-Hire Vehicles Registration Request (MCS115) Do you hold a valid intrastate operating authority certificate/permit? For-Hire Vehicles Registration Request (MCS115). YES NO Bulk Property Carrier Property Carrier Household Goods Carrier Exempt Operations - Property If no, and you are a passenger carrier you must also complete the 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. Title and registration records may be disseminated in accordance with §§46.2-208 through 46.2-214, to business, law enforcement or authorized government entities. American LegalNet, Inc. www.FormsWorkFlow.com VSA 14 (7/01/2012) Page 2 PLATE INFORMATION New Plates: (check one) Standard - (Blue and White) Heritage (Dogwood-Cardinal) Mountain to Seashore Patriot Autumn Great Seal Special Plate (enter type below)* GVWR or GCWR of 7,501 to 26,000 lbs. if used for business only; farm vehicles registered pursuant to § 46.2-698; taxicabs or other motor vehicles performing a taxicab service; common carrier vehicles Trailer Permanent - one-time fee (check one): Regular size plate Small size plate (trailer gross weight must be 4,000 lbs or less) Permanent Plate - may be issued to trailers, travel trailers, or semi-trailers; trucks/tractor trucks with a GVWR or GCWR of more than 26,000 lbs.; trucks/tractor trucks with For Hire Plate (enter description): Reissue Plates: (check one) Lost Mutilated/Destroyed Reissue Personalized Plates Illegible (examples: Taxi, Passenger For Hire, Truck For Hire, Tow Truck, Tractor For Hire, etc.) Confiscated I want a new plate design/character combination (Print your personalized character combination as it appears on your current license plates) * Virginia offers more than 200 unique plates for our citizens. 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. FARM INFORMATION You must complete this section if you entered "Farm Plate" as the special plate in the Plate Information section above. LOCATION ACREAGE TYPE OF COMMODITY ANNUAL AMOUNT PRODUCED Virginia Code § 46.2-698 permits a reduced fee for license plates used on farm vehicles with a gross weight of 7,500 lbs or more when used exclusively for farm use and not operated for hire. The reduced fee is one-half that for private carriers, but not less than $15. Total fees will be calculated at the time of processing. · Farm plates may be displayed on farm vehicles owned by the owner, renter, or operator of a farm of a size reasonably requiring use of the vehicle to transport: · Agricultural products of the farm to market or to other points of sale or processing. · Materials, tools, equipment,
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