Affidavit In Lieu Of Title Certificate
Affidavit In Lieu Of Title Certificate Form. This is a Virginia form and can be use in Department Of Motor Vehicles Statewide.
Tags: Affidavit In Lieu Of Title Certificate, VSA 12, Virginia Statewide, Department Of Motor Vehicles
AFFIDAVIT IN LIEU OF TITLE CERTIFICATE PURPOSE: VSA 12 (07/25/2012) Use this form to certify unavailability of a current certificate of title for a motor vehicle, trailer or semitrailer due to loss, unlawful detainment or other legitimate circumstance. INSTRUCTIONS: Complete form and have it notarized. Complete appropriate applications (see reverse for instructions). Submit all forms and applicable fees to DMV at the address above, attention Titling and Registration Work Center. INSURANCE COMPANIES ONLY: Submit all forms and applicable fees to DMV at the address above, attention Vehicle Branding Work Center. VEHICLE OWNER INFORMATION OWNER NAME (print) (if owner is an insurance company enter company name) IS OWNER AN INSURANCE COMPANY? YES -- If yes, vehicle MUST have been acquired as part of the claims process. Enter authorized agent/representative name in the space provided below. An additional $25.00 fee applies. NO -- See reverse for additional requirements/fees. OWNER TELEPHONE NUMBER CO-OWNER TELEPHONE NUMBER ( ( ) CO-OWNER NAME (print) AUTHORIZED AGENT/REPRESENTATIVE NAME (print) (insurance companies only) ) VEHICLE INFORMATION YEAR MAKE MODEL BODY TYPE COLOR VEHICLE IDENTIFICATION NUMBER (VIN) CERTIFICATION The owner(s) listed above 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. And, pursuant to Virginia Law, the owner(s) listed above, duly sworn, make the following statements: That I (we) submit this affidavit in support of my (our) application for a certificate of title, salvage certificate or non-repairable certificate for the vehicle described above. That I am (we are) unable to present a certificate of title with respect to the vehicle described above because: That additional facts pertinent to my (our) acquisition of the vehicle described above, including all efforts made to secure the title are: That, if the Commissioner of the Department of Motor Vehicles issues a certificate of title, salvage certificate or non-repairable certificate pursuant to my (our) application for same, herein above described, I (we) hereby bind myself (ourselves), my (our) heirs, assigns and personal representatives to indemnify and save harmless the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, or his successor in office, individually and officially, for any loss or damage which may be asserted against him or which he may sustain as a result thereof. OWNER OR AUTHORIZED AGENT/REPRESENTATIVE SIGNATURE CO-OWNER SIGNATURE DATE (mm/dd/yyyy) NOTARIZATION (must be completed by notary public) NOTARY PUBLIC SEAL (if required) Commonwealth of Virginia, city or county of _____________________________________ subscribed and sworn before me on this _________________ day of __________________________________________ (MONTH) (YEAR) by___________________________________________________ in the city or county and state aforesaid. REGISTRATION NUMBER (6 digits) MY COMMISSION EXPIRES (mm/dd/yyyy) NOTARY PUBLIC NAME NOTARY PUBLIC SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com VSA 12 (07/25/2012) Page 2 INSTRUCTIONS In order to register a motor vehicle, trailer or semitrailer, or to secure a new title for such a vehicle, the customer must submit a certificate of title. If unable to do so because the title is lost, unlawfully detained by someone who currently holds the title, or if the title is otherwise "not available", the customer may file an affidavit instead. When an insurance company files an affidavit, the affidavit must indicate that the vehicle was acquired as a result of the claims process. Efforts made by the applicant to obtain the certificate of title from the previous owner must also be documented. DMV will review the customer's applications and affidavit submitted along with information concerning the circumstances of the case. If DMV determines that the customer is entitled to registration and or titling, it will register the vehicle and issue a new registration card, license plate(s) and a certificate of title, salvage certificate or non-repairable certificate. Pursuant to Virginia Law, if the current certificate of title for a motor vehicle, trailer or semitrailer is unavailable due to legitimate circumstances, the steps below must be followed: 1. Applicant (owner) must complete and submit form VSA 12, Affidavit in Lieu of Title Certificate. 2. Applicant must complete and submit one of the following: a. b. c. d. Application for Certificate of Title and Registration, VSA 17A -- Applicants use this form to apply for a title and/or to register a passenger vehicle, truck, motor home (RV), trailer, motorcycle, or for-hire vehicle. Application for Certificate of Title - Manufactured Home, VSA 17B -- Applicants use this form to apply for a title to a manufactured home. Salvage Certificate Application, VSA 56 -- Applicants use this form to apply for a salvage certificate. Application For Non-Repairable Certificate, VSA 57 -- Applicants use this form to apply for a no-fee non-repairable certificate. Insurance companies use this form to apply for no-fee certificates for nonrepairable stolen vehicles or late model vehicles (current year and six preceding years) or any vehicle whose actual value is determined to have been at least $10,000 prior to being damaged. 3. Submit the above forms, applicable fees (visit www.dmvnow.com to obtain fees), title and sales and use tax, available original documents evidencing ownership and other supporting affidavits. 4. Insurance companies must submit a $25.00 processing fee in addition to the fees associated with the forms listed above. American LegalNet, Inc. www.FormsWorkFlow.com