Form Vsa 66 - Application For Transfer And Supplemental Liens
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1
2APPLICATION FOR
VSA 66 (12/20/2016)
TRANSFER AND SUPPLEMENTAL LIENS
Purpose:
Use this form to apply for a lien transfer or a supplemental lien.
Instructions:
Submit this form to any DMV customer service center with the appropriate fees. You may also mail the
form and fees to the Titling Work Center at the address above.
APPLICATION TYPE
CHECK ONE:
Transfer of Lien: Submit an original title unless the lienholder is a participant in the electronic title program. Complete sections
(1) Owner Information, (2) Vehicle Information, (3) Current Lien Information, (4) Transfer of Lien, and (6) Certification.
Supplemental Lien: Submit an original title unless the new lienholder is the same as the old lienholder and the lienholder is a
participant in the electronic title program. Complete sections (1) Owner Information, (2) Vehicle Information, (3) Current Lien
Information, (5) Supplemental Lien, and (6) Certification.
1. OWNER INFORMATION
OWNER FULL LEGAL NAME (last, first, middle, suffix)
TELEPHONE NUMBER
DMV CUSTOMER NUMBER / FEIN / SSN
(
)
CO-OWNER FULL LEGAL NAME (last, first, middle, suffix)
TELEPHONE NUMBER
DMV CUSTOMER NUMBER / FEIN / SSN
(
)
MAILING ADDRESS
CITY OR TOWN
STATE
ZIP CODE
Are any of the vehicle owners on active military duty or service?
YES
NO
2. VEHICLE INFORMATION
VEHICLE IDENTIFICATION NUMBER (VIN)
TITLE NUMBER
PLATE NUMBER
PLATE TYPE
YEAR
MAKE
MODEL
BODY TYPE
WEIGHT
3. CURRENT LIEN INFORMATION
Check One:
Printed original paper title certificate attached
Original title certificate is electronic title (no paper title attached)
LIENHOLDER NAME
LIENHOLDER CODE
LIEN DATE (mm/dd/yyyy)
FIRST
LIEN
LIENHOLDER MAILING ADDRESS
CITY OR TOWN
STATE
ZIP CODE
LIENHOLDER NAME
LIENHOLDER CODE
LIEN DATE (mm/dd/yyyy)
SECOND
LIEN
LIENHOLDER MAILING ADDRESS
CITY OR TOWN
STATE
ZIP CODE
4. TRANSFER OF LIEN
Complete this section only to transfer a lien to a new lienholder.
NEW LIENHOLDER NAME
LIENHOLDER CODE
DATE OF LIEN FILING (mm/dd/yyyy)
MAILING ADDRESS
CITY OR TOWN
STATE
ZIP CODE
5. SUPPLEMENTAL LIEN
Complete this section to add a lien. The priority of the security interest will be determined according to the date of the application filing
(Virginia Code § 46.2-637).
LIENHOLDER NAME
LIENHOLDER CODE
DATE OF LIEN FILING (mm/dd/yyyy)
MAILING ADDRESS
CITY OR TOWN
STATE
ZIP CODE
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