DATE (mm/dd/yyyy)
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.
Virginia Code, Section 46.2-730, requires that you certify that the antique vehicle, trailer, motorcycle or autocycle registered with antique plates is capable of
being safely operated on Virginia highways.
MAKE MODEL LICENSE PLATE NUMBERVEHICLE IDENTIFICATION NUMBER (VIN)VEHICLE TITLE NUMBER
OWNER SIGNATURE
DATE (mm/dd/yyyy)
CO-OWNER SIGNATURE
ANTIQUE LICENSE PLATE
APPLICANT CERTIFICATION
VSA 10B (07/01/2019)
Purpose: Owners of antique motor vehicles, antique trailers, antique motorcycles and antique autocycles use this form to certify
compliance with Code of Virginia requirements for use of antique plates.
Instructions: Return the completed VSA 10 B form (along with a VSA 10, VSA 14 or VSA 17A) with the one-time nonrefundable,
nontransferable $50 fee and any other applicable fees to any DMV customer service center. You may also mail the forms
and fees to DMV, Special Plates, P.O. Box 26668, Richmond, VA 23261-6668.
Virginia Code, Section 46.2-730, limits use of antique vehicles, trailers, motorcycles and autocycles registered with antique plates to the participation in club
activities, exhibits, tours, parades and similar events and to carrying or transporting passengers, personal effects and other antique vehicles for show
purposes. They may also be used on Virginia highways to test vehicle/trailer operation, obtaining maintenance or repairs and/or to sell the vehicle or trailer.
Antique plates permit occasional pleasure driving (not to exceed 250 miles from the owner's residence) but are not to be used for general transportation
purposes, including but not limited to, daily travel to and from the owner's place of employment.
Any owner of an antique vehicle, trailer, motorcycle or autocycle registered with license plates pursuant to Virginia Code, Section 46.2-730, will be guilty of a
Class 4 misdemeanor if convicted of a violation of antique plate usage. The conviction will cause the owner's registration for the vehicle involved in the
violation to be revoked for a five-year period from the date of conviction.
USE OF ANTIQUE PLATES
PENALTY FOR MISUSE OF ANTIQUE PLATES
VEHICLE SAFETY CERTIFICATION
Virginia Code, Section 46.2-730, requires evidence that the applicant named above owns or has regular use of another passenger car,
motorcycle or autocycle. Antique license plates will not be issued without this evidence. The vehicle must have active registration. If the
registration is inactive or the information is incorrect, the certification will not process.
I certify that I own at least one other properly registered vehicle, motorcycle or autocycle. (Describe below)
MAKE MODEL LICENSE PLATE NUMBERVEHICLE IDENTIFICATION NUMBER (VIN)VEHICLE TITLE NUMBER
STATE OF TITLE
I do not own another properly registered vehicle, motorcycle or autocycle; however, I certify that I have regular use of at least one
other properly registered vehicle, motorcycle or autocycle as authorized by the owner/co-owner below.
VEHICLE TITLE NUMBER
VEHICLE IDENTIFICATION NUMBER (VIN)
MAKE LICENSE PLATE NUMBER
MODEL
CO-OWNER FULL NAME (last, first, middile initial) (print)
OWNER FULL NAME (last, first, middile initial) (print)
CO-OWNER SIGNATURE
OWNER SIGNATURE
APPLICANT INFORMATION
OWNER FULL NAME (last, first, middile initial) (print)
CO-OWNER FULL NAME (last, first, middile initial) (print)
OWNER TELEPHONE NUMBER
CO-OWNER TELEPHONE NUMBER
STREET ADDRESS CITY STATE ZIPCODE
USE OF ANOTHER VEHICLE, MOTORCYCLE OR AUTOCYCLE
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.
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.
