VSA 98 (04/03/2013)
Purpose: A lienholder or lienholder's authorized agent uses this form to apply for a Virginia repossession title (in the
lienholder's name) for a repossessed vehicle that was titled in another state.
Instructions: Lienholders must complete all sections of this form. Use the State of Title/Requirements table on the back of
this form to indicate the state in which the vehicle is titled and to identify all of the required documents that
must be submitted. Mail completed form and required documents, along with the Application for Certificate of
Title and Registration (VSA 17A), to the Titling Work Center at the address above or present to any DMV
Customer Service Center.
Any willful misinformation given with fraudulent intent may be punishable as provided by law.
I hereby certify and affirm under penalty of perjury that the information contained in this application, both front and back, is
true and correct to the best of my knowledge; that this vehicle is in my possession with the intent of offering it for sale in
Virginia; and that I have met the requirements of all statutes in the State of Title for this motor vehicle, including the
requirements indicated for that state in the State of Title/Requirements section of this form. I understand it is unlawful to
knowingly make a false statement and any violation may be prosecuted as a felony as provided in Virginia law.
See Page 2 for State of Title/Requirements
REPOSSESSION OF VEHICLE
TITLED OUT-OF-STATE
CURRENT LIENHOLDER INFORMATION
LIENHOLDER NAME FEIN/DMV CUSTOMER NUMBER
MAILING ADDRESS CITY
STATE
ZIP CODE
LIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy)
VEHICLE INFORMATION
VEHICLE IDENTIFICATION NUMBER (VIN) TITLE NUMBER PLATE NUMBER
VEHICLE MAKE MODEL YEAR BODY TYPE WEIGHT
SUPPLEMENTAL LIEN INFORMATION
LIENHOLDER NAME LIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy)
ZIP CODE
STATE
CITYMAILING ADDRESS
LIENHOLDER NAME LIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy)
CITYMAILING ADDRESS
CERTIFICATION
LIENHOLDER NAME (print)
AUTHORIZED LIENHOLDER SIGNATURE DATE (mm/dd/yyyy)
DMV Use Only
TITLE RELEASED TO: DATE (mm/dd/yyyy)
TYPE OF IDENTIFICATION PRESENTED IDENTIFICATION NUMBER
NOTES
STATE
ZIP CODE
ISSUING STATE
