Fillable 5-DAY TRANSPORT CERTIFICATE (Virginia Department of Motor Vehicles)

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5-DAY TRANSPORT CERTIFICATE (Virginia Department of Motor Vehicles)

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5-DAY TRANSPORT CERTIFICATE
CERTIFICATE MUST BE IN POSSESSION OF PERSON OPERATING VEHICLE
DSD 5A (11/10/2015)
TRANSPORT VEHICLE FROM MOTOR VEHICLE AUCTION OR
OTHER POINT OF PURCHASE OR SALE.
TRANSPORT VEHICLE FOR REPAIRS, PAINTING OR INSTALLING PARTS OR
ACCESSORIES
TRANSPORT VEHICLE BETWEEN PROPERTIES OWNED OR
CONTROLLED BY THE SAME DEALERSHIP
TRANSPORT VEHICLE TO DEMONSTRATE TYPES OF VEHICLES FOR WHICH THE DEALER
DOES NOT HAVE APPROPRIATE PLATES.
REASON FOR USING 5-DAY TRANSPORT CERTIFICATE
DEALERSHIP NAME(print)
DEALER CERTIFICATE NUMBER
DEALERSHIP REPRESENTATIVE SIGNATURE
DATE (MM/DD/YYYY)
TITLE
TRANSPORT PLATE NUMBER
CERTIFICATE INFORMATION
ASSIGNED OPERATOR FULL LEGAL NAME (print) (last) (first) (middle) (suffix)
ADDRESS (street) (city) (state) (zip code)
ASSIGNED OPERATOR AND VEHICLE INFORMATION
ORIGINAL: VEHICLE OPERATOR COPY: DEALER
CERTIFICATE ISSUE TIME
AM
CERTIFICATE EXPIRE DATE (mm/dd/yyyy) CERTIFICATE EXPIRE TIME
PMAM
PM
VEHICLE TO BE OPERATED WITH THIS CERTIFICATE (YEAR) (MODEL) (IDENTIFICATION NUMBER)
CERTIFICATE ISSUE DATE (mm/dd/yyyy)
DEALER CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I
understand that knowingly making a false statement or representation on this form is a criminal violation.
Cut on the dotted line and give this copy to the dealer.
5-DAY TRANSPORT CERTIFICATE
CERTIFICATE MUST BE IN POSSESSION OF PERSON OPERATING VEHICLE
DSD 5A (11/10/2015)
TRANSPORT VEHICLE FROM MOTOR VEHICLE AUCTION OR
OTHER POINT OF PURCHASE OR SALE.
TRANSPORT VEHICLE FOR REPAIRS, PAINTING OR INSTALLING PARTS OR
ACCESSORIES
TRANSPORT VEHICLE BETWEEN PROPERTIES OWNED OR
CONTROLLED BY THE SAME DEALERSHIP
TRANSPORT VEHICLE TO DEMONSTRATE TYPES OF VEHICLES FOR WHICH THE DEALER
DOES NOT HAVE APPROPRIATE PLATES.
REASON FOR USING 5-DAY TRANSPORT CERTIFICATE
DEALERSHIP NAME(print)
DEALER CERTIFICATE NUMBER
DEALERSHIP REPRESENTATIVE SIGNATURE
DATE (MM/DD/YYYY)
TITLE
TRANSPORT PLATE NUMBER
CERTIFICATE INFORMATION
ASSIGNED OPERATOR FULL LEGAL NAME (print) (last) (first) (middle) (suffix)
ADDRESS (street) (city) (state) (zip code)
ASSIGNED OPERATOR AND VEHICLE INFORMATION
ORIGINAL: VEHICLE OPERATOR COPY: DEALER
CERTIFICATE ISSUE TIME
AM
CERTIFICATE EXPIRE DATE (mm/dd/yyyy) CERTIFICATE EXPIRE TIME
PMAM
PM
VEHICLE TO BE OPERATED WITH THIS CERTIFICATE (YEAR) (MODEL) (IDENTIFICATION NUMBER)
CERTIFICATE ISSUE DATE (mm/dd/yyyy)
DEALER CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I
understand that knowingly making a false statement or representation on this form is a criminal violation.
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5-DAY TRANSPORT CERTIFICATE (Virginia Department of Motor Vehicles)

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Completed 2 November 2020

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