REBUILT VEHICLE
DISCLOSURE STATEMENT
VSA 59 (07/01/2017)
Purpose: Use this form when selling a vehicle to disclose the fact that the vehicle is a "rebuilt" vehicle.
Instructions: Seller enters rebuilt vehicle information. Seller and buyer must sign and each retain a copy.
VIRGINIA CODE INFORMATION (read carefully)
Virginia Code §46.2-1602(A)(4) states that "It shall be unlawful for any person to sell a rebuilt vehicle without first having disclosed the fact
that the vehicle is a rebuilt vehicle to the buyer."
Virginia Code §46.2-1600 defines a rebuilt vehicle as: (i) any salvage vehicle that has been repaired for use on the public highways, or
(ii) any late model vehicle that has been repaired and the estimated cost of repair exceeded 75% of its actual cash value, excluding the cost
to repair damage to the engine, transmission or drive axle assembly.
REBUILT VEHICLE INFORMATION
NOTICE: The certificate of title issued by the Virginia Department of Motor Vehicles for the above mentioned vehicle has been branded
"rebuilt." The title may indicate a "brand" carried forward from another state or be based upon a vehicle examination conducted by a DMV
agent.
SIGNATURES
SELLER SIGNATURE
BUYER SIGNATURE
VEHICLE IDENTIFICATION NUMBER (VIN) YEAR MAKE BODY TYPE TITLE NUMBER STATE
SELLER NAME (print)
BUYER NAME (print)
DATE (mm/dd/yyyy)
DATE (mm/dd/yyyy)
