TEMPORARY CERTIFICATE OF
VSA 01 (07/01/06)
REGISTRATION VALID FOR 30 DAYS
Dealers selling automobiles or trucks must complete this form to issue a temporary certificate of registration. 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.
TEMPORARY TAG NUMBER
PREVIOUS OWNER'S NAME
DEALER LICENSE NUMBER
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.
DATE OF SALE
STATE IN WHICH VEHICLE WILL BE LICENSED
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.
DEALER REPRESENTATIVE'S SIGNATURE
DISTRIBUTION: ORIGINAL COPY - TITLED IN VIRGINIA, SUBMIT WITH TITLE APPLICATION
FIRST COPY SECOND COPY
TITLED OUT OF STATE, FORWARD IMMEDIATELY TO DMV, RICHMOND