REGISTRATION PERIOD (check one:)
TRANSFER
THREE YEARS ($3 discount - not for emissions area)
TWO YEARS ($2 discount)ONE YEAR
(enter plate number)
REGISTRATION TYPE (check one:)
FOR HIRE (complete For Hire Information below)RENTALPRIVATE
REGISTRATION INFORMATION
NOTE: Virginia offers more than 200 unique plates for our customers. Please visit www.dmvNow.com for a listing of special plates available. Not all plates are
available for all vehicle types and some special plates require a certification form. Review our website for additional information.
Trailer Permanent - (one time fee) select size: Small size plate (trailer gross weight must be 4,000 lbs or less) Regular size plate
Check to indicate how the vehicle being registered will be used (check all that apply). If the vehicle will be used in property carrier operations, and those
operations exclusively use passenger cars, motorcycles, autocycles, mopeds, or vehicles with a gross vehicle weight rating (GVWR) of 10,000 pounds or less,
then registration for hire is not required.
Do you hold a valid intrastate operating authority certificate/permit?
If no, and you are a passenger carrier you must also complete the For-Hire Vehicles Registration Request (MCS115).
FOR HIRE INFORMATION
YES NO
Common Carrier - Regular Route Employee Hauler Sight-seeing Carrier Property Carrier *
Common Carrier - Irregular Route Contract Passenger Carrier Non-Emergency Medical Transport Household Goods Carrier *
Nonprofit/Tax-Exempt Taxicab Exempt Operations - Passengers * Exempt Operations - Property *
* You must also complete the For-Hire Vehicles Registration Request (MCS115)
PROPERTY CARRIER OPERATIONSPASSENGER CARRIER OPERATIONS
I/We 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.
DATE (mm/dd/yyyy)
DATE (mm/dd/yyyy)
APPLICANT NAME (print) SIGNATURE OF APPLICANT
SIGNATURE OF CO-APPLICANTCO-APPLICANT NAME (print)
CERTIFICATION
POWER OF ATTORNEY FOR NON-RESIDENT(S) AND CORPORATION(S) NOT DOMICILED IN VIRGINIA: Pursuant to the provisions of Virginia Code
§46.2-601, I/we appoint the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, to be my/our true and legal agent upon whom
all legal processes against me/us may be served in any legal proceeding arising from the operation and/or use of any motor vehicle registered in my/our name(s)
in the Commonwealth of Virginia. I/we agree that any lawful process or notice to me/us which is served on the Commissioner shall have the same legal effect as
if served on me/us within the Commonwealth of Virginia.
PRIVACY NOTICE: The information, including Social Security Number, is requested in accordance with Virginia Code §§46.2-623 and 46.2-629. Any person
who refuses to supply the required information will be denied a certificate of title and/or registration. By signing this form, you authorize DMV’s exchange of title
and registration records with business, law enforcement, or government entities and you authorize DMV’s exchange of title and registration records in accordance
with Va. Code §§46.2-208 through 46.2-214 and 18 U.S.C. 2721.
NOTICE
PROOF OF ADDRESS (specify proof document(s) presented)
IF HELD, REASON: CSR STAMP
TOTAL $
DMV USE ONLY
SALES PRICE $ TITLE FEE $
PROCESSING FEE $ TRANSFER FEE $
SALES & USE TAX $
REGISTRATION FEE
$
WITH LIEN? NOYES
PERSONAL PROPERTY TAX RELIEF ELIGIBILITY
1. Answer the questions below to determine if your vehicle qualifies for car tax relief. YES NO
a. Is more than 50% of the vehicle's annual mileage used as a business expense for federal income tax purposes OR reimbursed by an employer?
b. Is more than 50% of the depreciation associated with the vehicle deducted as a business expense for federal income tax purposes?
c. Is the cost of the vehicle expensed pursuant to Section 179 of the Internal Revenue Service Code?
d. If the vehicle is leased by an individual, does the leasing company pay the tax without reimbursement from the individual?
2. If you answered YES to ANY of the above questions, check Business Use. Your vehicle is considered by State law to have a business use and does NOT
qualify for Personal Property Tax Relief.
3. If you answered NO to ALL of the above questions, check Personal Use and answer the question below.
BUSINESS USE
PERSONAL USE -- Is this vehicle held in a private trust for non-business purposes by an individual beneficiary? YES NO
UMV FEE $
INSURANCE CERTIFICATION
I/We certify that (check one):
This vehicle is insured by a liability policy issued through an insurance company licensed to do business in Virginia and
it will remain insured while registered, whether or not it is operated. Penalties are severe for violation of this
requirement. Be advised that the amount of liability coverage required is higher for vehicles that are operated for hire.
NAME OF INSURANCE COMPANY
This vehicle is not insured; therefore, I am remitting the applicable uninsured motor vehicle fee. (This fee provides no insurance coverage.) A vehicle must be
insured with liability coverage when it is registered, and it must remain insured while registered, whether or not it is operated, or the uninsured motor vehicle
fee must be paid. Penalties are severe for violation of this requirement.
VSA 17A (07/01/2019) Page 2
