Fillable Form Vsa 14 - Vehicle Registration Application printable pdf download

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:

One Year

Two Years ($2 discount applies)

(check one)

Registration Type:

Original

Renewal

Private

Reissue (Plates & Decals)

(check one)

See Reissue Plates below under

Reissue (Decals Only)

Rental Vehicle

Transfer License Plate Number:

Plate Information.

ENTER PLATE NUM

(Vanpool) (Cannot exceed 16 passengers including driver.) Seating Capacity

For Hire (complete "For Hire Information" section)

Ridesharing

Amateur Radio Operator Call Letters* --

Specify letters:

Other:

* Vehicle must be equipped according to Virginia law.

SPECIFY

OWNER INFORMATION

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 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)

CITY

STATE

ZIP CODE

CO-OWNER'S RESIDENCE/HOME/BUSINESS ADDRESS (Apt # if applicable)

CITY

STATE

ZIP CODE

OWNER EMAIL ADDRESS

CO-OWNER EMAIL ADDRESS

ADDITIONAL INFORMATION

Are any of the owners/lessees on active

LOCATION WHERE VEHICLE IS PRINCIPALLY GARAGED

IF NEW LOCATION ENTER DATE CHANGED

military duty or service?

YES

CITY

COUNTY

TOWN OF

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

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

VEHICLE INFORMATION

TITLE NUMBER

VEHICLE IDENTIFICATION NUMBER (VIN)

CURRENT PLATE NUMBER

EXPIRATION DATE (mm/dd/yyyy)

YEAR

MAKE

MODEL

BODY TYPE

AXLES

FUEL

SEATING CAPACITY (including driver)

GROSS VEHICLE

GROSS COMBINATION

EMPTY WEIGHT

GROSS WEIGHT

PRIMARY

SECONDARY

VEHICLE

WEIGHT RATING

COLOR

GVWR

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

Bulk Property Carrier

Common Carrier - Irregular Route

Contract Passenger Carrier

Non-Emergency Medical Transport

Property Carrier

Nonprofit/Tax-Exempt

Taxicab

Exempt Operations - Passengers *

Household Goods Carrier

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

Exempt Operations - Property

Do you hold a valid intrastate operating authority certificate/permit?

If no, and you are a passenger carrier you must also complete the

YES

For-Hire Vehicles Registration Request (MCS115).

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.

Form Vsa 14 - Vehicle Registration Application

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