TEMPORARY CERTIFICATE OF REGISTRATION VSA 01 (07/01/06) VALID FOR 30 DAYS Purpose: Dealers selling automobiles or trucks must complete this form to issue a temporary certificate of registration. Instructions: This completed form serves as a vehicle's temporary registration until the permanent registration is received. It must accompany the driver while the vehicle is in operation. PURCHASER'S NAME YEAR MAKE ADDRESS BODY STYLE TEMPORARY TAG NUMBER IDENTIFICATION NUMBER PREVIOUS OWNER'S NAME ADDRESS CITY STATE IN WHICH VEHICLE WILL BE LICENSED STATE ZIP DEALER'S NAME ADDRESS CITY STATE ZIP DATE OF SALE EXPIRATION DATE DEALER LICENSE NUMBER CHECK ONE: If title or certificate of origin is not available, check one: First temporary registration Second temporary registration Virginia law states that a motor vehicle liability policy must be issued by a company licensed to do business in Virginia. The policy must provide at least minimum coverage as required by law. Failure to maintain insurance or pay the uninsured motor vehicle fee will result in suspension of your driver's license and vehicle registration. - This vehicle is insured by a policy that meets the above requirements. - This vehicle will be licensed in Virginia and is not insured by a policy meeting the above requirements. (Submit the full uninsured motor vehicle fee with the original registration application.) - This vehicle will be licensed out of state and is not insured by a policy meeting the above requirements. (Submit one-twelfth of the annual uninsured motor vehicle fee with the application.) NOTE: Payment of UMV fee does not provide insurance coverage. PURCHASER'S SIGNATURE DATE DEALER REPRESENTATIVE'S SIGNATURE DISTRIBUTION: ORIGINAL COPY - TITLED IN VIRGINIA, SUBMIT WITH TITLE APPLICATION - TITLED OUT OF STATE, FORWARD IMMEDIATELY TO DMV, RICHMOND FIRST COPY - PURCHASER SECOND COPY - DEALER American LegalNet, Inc. www.FormsWorkFlow.com VSA 01 (07/01/06) VIRGINIA MOTOR VEHICLE CODE Dealer Licensing Act Temporary Registrations 1 - Temporary certificates of registration are only valid for 30 days from the date of issuance. A temporary certificate of registration issued by a dealer to a purchaser will automatically expire when DMV issues a certificate of title for the vehicle. If the dealer fails to produce a certificate of title or a certificate of origin, or fails to apply for a replacement certificate of title, the purchaser's interest in the vehicle may terminate and the purchaser may return the vehicle to the dealer, provided that certain conditions are met, and obtain a full refund of all payment made towards the purchase of the vehicle, less any damage to the vehicle and less a reasonable amount for use, not to exceed one-half the amount allowed per mile by the Internal Revenue Service. 2 - If the certificate of title or certificate of origin is not produced within thirty days, the dealer must submit the application for title, a copy of the bill of sale, fees and a written statement of facts. A second temporary certificate may then be issued. If the dealer does not produce the certificate of title or certificate of origin before the second temporary certificate expires, the purchaser's rights to the vehicle may terminate as outlined in Item 1 above. 3 - If the dealer is unable to produce the certificate of title or certificate of origin within the sixty-day period from the date of issuance of the first temporary certificate, the Department may extend temporary registration for one additional period of up to ninety days, provided the dealer makes application in the format required by DMV. If the dealer does not produce the certificate of title or certificate of origin to the vehicle before the expiration of the additional ninety-day period, the purchaser's interest in the vehicle may terminate as outlined in Item 1 above. American LegalNet, Inc. www.FormsWorkFlow.com