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TEMPORARY CERTIFICATE OF

VSA 01 (07/01/06)

REGISTRATION VALID FOR 30 DAYS

Purpose: Instructions:

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.

PURCHASER'S NAME

ADDRESS

TEMPORARY TAG NUMBER

PREVIOUS OWNER'S NAME

ADDRESS

CITY

STATE

ZIP

EXPIRATION DATE

DEALER'S NAME

ADDRESS

CITY

STATE

ZIP

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

YEAR

MAKE

BODY STYLE

IDENTIFICATION NUMBER

STATE IN WHICH VEHICLE WILL BE LICENSED

CHECK ONE:

  • -

    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

FIRST COPY SECOND COPY

  • -

    TITLED OUT OF STATE, FORWARD IMMEDIATELY TO DMV, RICHMOND

  • -

    PURCHASER

  • -

    DEALER

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