REPOSSESSION OF VEHICLE TITLED OUT-OF-STATE
REPOSSESSION OF VEHICLE TITLED OUT-OF-STATE
VSA 98 (06/15/2021)
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.
LIENHOLDER NAME
CURRENT LIENHOLDER INFORMATION
FEIN/DMV CUSTOMER NUMBER
MAILING ADDRESS
CITY
STATE
ZIP CODE
LIENHOLDER CODE
DATE OF LIEN (mm/dd/yyyy)
VEHICLE IDENTIFICATION NUMBER (VIN) VEHICLE MAKE
VEHICLE INFORMATION
TITLE NUMBER
ISSUING STATE
PLATE NUMBER
MODEL YEAR
BODY TYPE
WEIGHT
LIENHOLDER NAME MAILING ADDRESS LIENHOLDER NAME MAILING ADDRESS
SUPPLEMENTAL LIEN INFORMATION
LIENHOLDER CODE
CITY
LIENHOLDER CODE
CITY
DATE OF LIEN (mm/dd/yyyy)
STATE
ZIP CODE
DATE OF LIEN (mm/dd/yyyy)
STATE
ZIP CODE
CERTIFICATION 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.
LIENHOLDER NAME (print)
AUTHORIZED LIENHOLDER SIGNATURE
DATE (mm/dd/yyyy)
TITLE RELEASED TO: TYPE OF IDENTIFICATION PRESENTED NOTES
See Page 2 for State of Title/Requirements DMV Use Only
IDENTIFICATION NUMBER
DATE (mm/dd/yyyy)
VSA 98 (06/15/2021) Page 2
STATE OF TITLE / REQUIREMENTS
1. Identify the state where the vehicle was titled. 2. Obtain required repossession documents as indicated for that state. Check the box(es) to indicate all documents have been
submitted.
State of Title
Title Required?
Alabama Alaska Arizona
Arkansas
California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine
Maryland
Massachusetts Michigan Minnesota Mississippi
Missouri
Montana Nebraska Nevada New Hampshire New Jersey
New Mexico
New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania
Rhode Island
South Carolina South Dakota Tennessee Texas Utah Vermont Washington West Virginia Wisconsin Wyoming
Yes Yes Yes
Yes
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes
No
Yes No No Yes
Yes/No
No Yes Yes Yes Yes
Yes
No Yes Yes Yes No Yes Yes
Yes
Yes No Yes Yes Yes Yes Yes Yes No Yes
Form Required for State of Title
MVT 15-1 843 N/A Affidavit of Repossession of Motor Vehicle
REG 119 DR-2393 H-30 MV-195 N/A HSMV 82040 T-16 N/A ITD 3366 VSD 609.3 39738 411067 TR-84 TD 96-192 N/A MVT-5
Notice of Security Interest Filing T20145
TR-10, TR-11L PS2024 78-012 OR 78-010
DOR 5005
MV-11 OR RMV37A N/A VP020, Notarized TDMV 16 OS/SS-55, OS/SS-57
MVD-10012 , MVD-10187, MVD-10468, MVD-10009
MV-950 MVR-3 SFN 2880 N/A 737 735-263
MV-217, MV-217A Affidavit for Repossession, Notarized
4034 DOR-MV215 RV-F1312101, RV-F1315201
VTR-264 TC-569B TA-VT-11 TD-420-042, Notarized DMV-129-TR, DMV-1-TR MV2117 N/A
Copy of Security Agreement Required?
No No No
Yes
Yes No No Yes Yes - certified No No No No No No No Yes - certified Yes - certified No No
No
No No No Bill of Sale
No
Yes No No No No
No
No No No Yes - certified Yes - certified No Yes
No
No Yes No Yes No No No No No No
Other Required Documentation
None None None
None
Odometer Disclosure Statement None Q-1 None Affidavit of Repossession HSMV 82042 MV-1 Certificate of Repossession None None Certificate of Repossession None None None None None
None
None None None None If no title submitted,Form DOR-4809 or DOR-108 is required None Affidavit of Repossession None None None
None
None None None None None None None
None
None
Lien Instrument, Affirmation of Repossession
RV-F1315201 None None Bill of Sale None Odometer Disclosure Statement None Affidavit of Repossession
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