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Get VA VSA 10B 2019-2024

VSA 10B 07/01/2014 ANTIQUE LICENSE PLATE APPLICANT CERTIFICATION Purpose Instructions 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. Return the completed VSA 10 B form along with a VSA 10 VSA 14 or VSA 17A with the one-time 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. APPLICANT INFORMATION OWNER FULL NAME last first middile initial print OWNER TELEPHONE NUMBER CO-OWNER TELEPHONE NUMBER CO-OWNER FULL NAME last first middile initial print STREET ADDRESS CITY STATE ZIPCODE USE OF ANOTHER VEHICLE MOTORCYCLE OR AUTOCYCLE 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 VEHICLE TITLE NUMBER VEHICLE IDENTIFICATION NUMBER VIN MAKE MODEL LICENSE PLATE NUMBER 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. STATE OF TITLE VEHICLE IDENTIFICATION NUMBER VIN OWNER SIGNATURE 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. 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. USE OF ANTIQUE PLATES 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. PENALTY FOR MISUSE OF ANTIQUE PLATES 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* VEHICLE SAFETY CERTIFICATION being safely operated on Virginia highways.

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