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Get VA LES 022A 2006

NS: Complete three copies of this form. Present forms with any receipts and supporting documents to the Department of Motor Vehicle Law Enforcement Agent. A statutory fee is required for all salvage vehicle exams. OWNER/COMPANY INFORMATION COMPANY/INDIVIDUAL NAME CONTACT PERSON NAME ADDRESS TELEPHONE NUMBER CITY ( STATE ) ZIP CODE REBUILDER CERTIFICATE NUMBER ADDRESS WHERE VEHICLE IS LOCATED (if other than above) VEHICLE INFORMATION (All information below must be completed prior to exam.

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