REPOSSESSION OF VEHICLE TITLED OUT-OF-STATE

1 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.

2 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 NUMBERMAILING ADDRESSCITYSTATEZIP CODELIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy) VEHICLE INFORMATION VEHICLE IDENTIFICATION NUMBER (VIN) TITLE NUMBER PLATE NUMBERVEHICLE MAKE MODEL YEAR BODY TYPE WEIGHT SUPPLEMENTAL LIEN INFORMATION LIENHOLDER NAME LIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy)ZIP CODESTATECITYMAILING ADDRESSLIENHOLDER NAME LIENHOLDER CODE DATE OF LIEN (mm/dd/yyyy)CITYMAILING ADDRESSCERTIFICATION LIENHOLDER NAME (print)AUTHORIZED LIENHOLDER SIGNATUREDATE (mm/dd/yyyy)DMV Use Only TITLE RELEASED TO:DATE (mm/dd/yyyy)TYPE OF IDENTIFICATION PRESENTEDIDENTIFICATION NUMBERNOTESSTATEZIP CODEISSUING STATEVSA 98 (04/03/2013)

3 NoneNoneMassachusetts 20145, NotarizedMichigan TR-10 Minnesota PS2024 Mississippi 78-012 ORMissouri DOR 5005 Montana MV-11 ORNebraska N/A Nevada VP020, NotarizedNew Hampshire TDMV 16 New Jersey ISM/SS-57 New Mexico MVD-10012 New York MV-950 North Carolina MVR-3 North Dakota SNF 2880 Ohio P-076a Oklahoma 737 Oregon 735-263 Pennsylvania Rhode Island South Carolina 4034 South Dakota DOR-MV215 Tennessee RV-F1312101 Texas VTR-264, Notarized TC-569B Vermont TA-VT-11 Washington TD-420-042, Notarized West Virginia DMV-129-TR Wisconsin MV2117 Wyoming N/A UtahNo No No No No No Odometer Disclosure StatementAffidavit of RepossessionNoneNoneNoneNoneYesYesYesYes NoYesNoneYesYesNo Yes NoneNoneNoneYesNoYesYes - if lien is not recorded on titleYes - certifiedNo No NoneNoneNoneNoneMV-217 Affidavit for REPOSSESSION , NotarizedNoYesYesYesYes Yes No No No No Yes - certifiedNoneAffirmation of RepossessionNoneNoneNoneYesYesNoYesYesYe sNo No No NoneAffidavit of RepossessionNoneNone79-010No No No No Yes - copy of Notice of Lien Receipt or Title with LienNoneNoneIdaho Illinois VSD Indiana 39738 or 53330 (Dealer)Iowa 411067 Kansas TR-84 Kentucky TD 96-192 Louisiana DPSMV 1976 (R0409)

4 Maine MVT-5 Maryland Notice of Security Interest Filing No Yes - certifiedNo Yes - certifiedNotarized contractNo No NoneNoneNoneNoneTermination StatementNoneNoneAffidavit Recondition ReportITD 3366 YesNoYesYesYesYesYesYesNoYesNoNoYesNoNoY esYesYesYes Yes - certifiedYes RMV37 ANoneOdometer Disclosure StatementHawaii Certificate of RepossessionN/ADistrict of Columbia Florida Georgia HSMV 82048 Yes - certified Affidavit of RepossessionNoneNoneYes - if not recorded on title or MSONo N/AT-16 Colorado Connecticut Delaware No No YesNoneQ-1 NoneDR-2393 H-30, NotarizedMV-518 if dealer satisfies lienMV-195 OR YesYesYesYesYesYesYesCalifornia YesREG 119 YesOdometer Disclosure StatementNo Verification of Ownership1. 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 of Title Copy of Security Agreement Required?

5 Other Required DocumentationAlabama No Alaska No Arizona No Arkansas Form Required for State of TitleSTATE OF TITLE / REQUIREMENTS NoneNoneNoneNonePage 2843 48-0902 Affidavit of REPOSSESSION of Motor VehicleMVT 15-1 Title Required?YesYesYesYesYes