How to fill out the VSA 5 in Virginia
A field-by-field walkthrough of the Virginia VSA 5 (Odometer Disclosure Statement) for licensed used car dealers — what goes in every section, who signs what, and the documents you attach. Verified against the official form as of October 2026.
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Filling out the VA VSA 5 after a sale:
- What it is
- Virginia's non-secure odometer disclosure statement, for transfers where the title has no place for the disclosure
- Who completes it
- The seller enters the reading, checks one box, prints their name and signs; the buyer prints their name, signs, and certifies they received a copy
- Where to file it
- Attached to the title with the VSA 17A title application at the DMV. You keep a copy for 5 years
- Processing time
- None of its own. It's processed with the title application
- Cost
- Free PDF from the DMV. The form has no fee line
This guide is informational and does not replace the official Virginia instructions. Always confirm the current form and procedure with the Virginia Department of Motor Vehicles (DMV) before you file.
The VSA 5 is one car's paperwork. A 20-second read on your lot, and the tax-and-fee math for the whole deal — built for dealers, no signup. Free calculators dealers actually use — no signup, no email.
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What the VSA 5 is and why it matters
The VSA 5 is Virginia's Odometer Disclosure Statement: the seller's mileage statement on its own page. Section 46.2-629 of the Code of Virginia requires the seller, including a dealer, to record the odometer reading on the title and on the title application. Most Virginia deals do that on the title's assignment section or on a secure dealer reassignment (VAD-20), so most deals never touch a VSA 5.
The VSA 5 covers the gaps. The DMV lists it for older titles with no disclosure section, for correcting a wrong reading when the title's reassignments are full, and for lease returns. This guide walks every box on the 07/01/2021 revision, says when a dealer can use it and when the DMV wants a secure form instead, and covers the exemptions and the five-year record rule.
The current revision is VSA 5 (07/01/2021), a one-page fillable PDF from the Virginia DMV. The top of the form says "Do not use this form if a title exists for this vehicle," and the DMV's dealer guidance says licensed dealers should disclose on a secure document. So for a dealer the VSA 5 is a narrow fallback, not a form for every deal. You can upload the blank PDF to DealerVLO once under Settings → Forms. The state's field names are generic ("TextFieldnew[3]"), and two are misnamed: the VIN box and the seller-name box are both called "Odometer_Reading." DealerVLO recognizes this form and suggests a mapping for each box, with the VIN box pointed at the VIN. Check each suggestion once against the table in this guide before you save. The signature and date lines aren't fields at all; they're written in ink.
Documents to have before you start
Gather these before you complete the VSA 5. A missing attachment is the number-one reason the the Virginia Department of Motor Vehicles (DMV) bounces a title application back.
- The title, assigned to the buyer — The DMV's guidance says a non-conforming title (one with no place for both parties to sign and print their names for the odometer) must have a VSA 5 attached.
- The VSA 17A title application — The DMV checks that the odometer field is completed on the VSA 17A as well as on the disclosure document. Same number on both. See the VSA 17A guide.
- A dealer letter, when the VSA 5 corrects a reading on a dealer sale — The DMV's correction procedure says a licensed dealer must provide a letter on dealership letterhead explaining the correction, with supporting documents.
- The out-of-state title showing the exemption, if you check the exempt box — The form's fourth box says the applicant must present it.
VSA 5, section by section
When a Virginia dealer can use the VSA 5
Start with the form's own line: do not use it if a title exists. Then read the DMV's Vehicle Licensing Guide (VLIC-3.520, revised 07/01/2021), which is more specific. It says licensed dealers should disclose the odometer reading on a secure document: the title's own disclosure section, a secure dealer reassignment (VAD-20), or the secure power of attorney (VAD-70A) when the title is lost or held by the lender. It then lists the cases where the VSA 5 is accepted. An individual selling on a non-conforming title, which is a common way a dealer receives one when buying from a private party. A dealer selling a new vehicle on an MSO. A lessee disclosing to the lessor. And a dealer correcting a reading that was recorded wrong on an assignment, when all reassignments are already completed on the title or secure reassignment form. The guide also says that when a dealer receives an older title with no disclosure section, the first resale goes on a secure dealer reassignment, not a VSA 5.
| Field | Who fills it |
|---|---|
Conforming title (has a disclosure section) Disclose on the title or a VAD-20. No VSA 5. | You (dealer) |
Title lost or held by the lender at the sale The DMV says the VAD-70A must be used. Not a VSA 5. | You (dealer) |
Buying from a private seller on a non-conforming title The seller completes a VSA 5; you sign as buyer. | You (dealer) |
Correcting a wrong reading with all reassignments full Secure form first; the DMV allows a VSA 5 if none is available. | You (dealer) |
Vehicle information
The top row is the vehicle: VIN, make, body type, model and year. Copy them from the title so they match the VSA 17A. In the state's PDF the VIN box is the field named "Odometer_Reading[1]". DealerVLO recognizes this form and suggests the VIN for it, not the mileage. Confirm that before you save.
| Field | Who fills it |
|---|---|
Vehicle identification number PDF field "Odometer_Reading[1]". Should be mapped to the VIN, not the mileage. | You (dealer) |
Make PDF field "TextFieldnew[0]". | You (dealer) |
Body type PDF field "TextFieldnew[1]". | You (dealer) |
Model PDF field "TextFieldnew[2]". | You (dealer) |
Year PDF field "TextFieldnew[3]". | You (dealer) |
Seller certification: the reading and the four boxes
Enter the odometer reading with no tenths, then check one box only. Unlike some states' forms, the VSA 5 has a box for actual mileage, so one box is always checked. "In excess of odometer's mechanical limits" is for an odometer that has rolled over; the DMV records it with the code E. "Is not the actual mileage" carries the odometer-discrepancy warning; the DMV records it as N, and the new title shows that brand. Under 49 CFR 580.5(e), use it only when you know the reading differs from the true mileage by more than calibration error. The DMV's guide notes that an E or N code lowers the value of the vehicle and that the brand is permanent. The fourth box is for a vehicle that was exempt in the prior state of title, and the buyer must present that out-of-state title. In the PDF each box is its own checkbox, so DealerVLO can tick the actual, exceeds, or not-actual box from the deal's odometer status. The PDF's hover labels on the exceeds and not-actual boxes are swapped, so go by position on the page: second box exceeds, third box not actual. DealerVLO's suggested mapping already does. It has no setting for the exempt box; check that one by hand.
| Field | Who fills it |
|---|---|
Odometer reading (no tenths) PDF field "TextFieldnew[4]". Read it off the dash at the sale. | You (dealer) |
The actual mileage PDF field "CheckBox1[0]". | You (dealer) |
In excess of mechanical limits PDF field "CheckBox1[1]". | You (dealer) |
Not the actual mileage (warning, odometer discrepancy) PDF field "CheckBox1[2]". | You (dealer) |
Exempt in prior state of title PDF field "CheckBox1[3]". Leave it unmapped; check by hand when it applies. | You (dealer) |
Seller name, signature and address
Under the certification, the seller affirms under penalty of perjury that the form and supporting documents are true and that a knowingly false statement is a criminal violation. Then the seller's printed name, signature and date, and the street address, city, state and ZIP. When your dealership is the seller, the DMV's guide says the printed name doesn't have to be hand-printed for dealership transactions: a computer-generated, typed or stamped name is fine as long as the signature is original. If there are several sellers, only one has to sign. The signature and date have no fields in the PDF, so write them in ink.
| Field | Who fills it |
|---|---|
Seller name (print) PDF field "Odometer_Reading[0]". DealerVLO leaves it blank. Map it to your dealership name if you want it typed, or let the signer print it. Never the mileage. | You (dealer) |
Seller signature No field. Original signature in ink. | You (dealer) |
Date (mm/dd/yyyy) No field. Write it by hand. | You (dealer) |
Seller street address PDF field "TextFieldnew[8]". | You (dealer) |
City / State / ZIP code PDF fields "TextFieldnew[7]", "[5]" and "[6]". | You (dealer) |
Buyer certification
The bottom block is the buyer's: "By signing below I acknowledge and certify that I have received a copy of this completed form." The buyer prints their name, signs and dates it, and gives their street address, city, state and ZIP. You can fill the name and address from the deal. The buyer signs their own line, and you hand them the copy the certification says they received. When you buy a car from a private seller on a VSA 5, your dealership is the buyer here.
| Field | Who fills it |
|---|---|
Buyer name (print) PDF field "TextFieldnew[9]". Can be filled from the deal. | Buyer |
Buyer signature No field. The buyer's own signature. | Buyer |
Date (mm/dd/yyyy) No field. | Buyer |
Buyer street address PDF field "TextFieldnew[10]". | Buyer |
City / State / ZIP code PDF fields "TextFieldnew[11]", "[12]" and "[13]". | Buyer |
Exemptions, penalties, and the 5-year rule
Federal exemptions are in 49 CFR 580.17: model year 2010 and older; model year 2011 and newer once 20 years have passed since January 1 of the model year; vehicles over 16,000 pounds GVWR; and vehicles that aren't self-propelled. Section 46.2-629 exempts vehicles over 16,000 pounds GVWR and older vehicles that were exempt in another state, and the DMV honors those other states' exemptions but still records the reading. Knowingly recording a wrong reading is unlawful, and a violation of the section is a Class 1 misdemeanor. On records, 49 CFR 580.8 requires a dealer to keep a copy of every odometer statement it issues and every one it receives for five years. That includes the VSA 5 a private seller gives you, not only the ones you give buyers.
| Field | Who fills it |
|---|---|
Copy of every VSA 5 you issue or receive, kept 5 years Electronic copies count if they can't be altered without detection. | You (dealer) |
Common VSA 5 mistakes that cause rejections
The form says not to use it when a title exists. Disclose on the title's reassignment or a secure VAD-20.
The DMV says the secure power of attorney (VAD-70A) must be used when the title is lost or held by the lienholder at the sale.
Both fields are named "Odometer_Reading" in the state's PDF. DealerVLO's suggestion points the VIN box at the VIN and leaves the seller name blank. Check both before you save the form.
The form says check one box only. Actual mileage has its own box on the VSA 5, so one is always checked.
The DMV checks the odometer field on the VSA 17A against the disclosure document. Copy the same whole number.
The DMV's correction procedure requires a letter on dealership letterhead explaining the correction, with supporting documents, and VOID written in the reassignment with the wrong reading.
Common questions
Where do I get a Virginia odometer statement?+
The DMV publishes it as the VSA 5, a free one-page fillable PDF on dmv.virginia.gov. The current revision is 07/01/2021. The download button at the top of this guide links straight to it.
Can a Virginia dealer use the VSA 5 instead of the title?+
Not as a rule. The form says not to use it if a title exists, and the DMV's dealer guidance says licensed dealers should disclose on a secure document: the title, a secure dealer reassignment (VAD-20), or a VAD-70A when the title is lost or with the lender. The DMV accepts a VSA 5 from a dealer mainly for correcting a wrong reading when the reassignments are full and no secure form is available.
Does the VSA 5 need to be notarized?+
No. The form has no notary block. The seller certifies under penalty of perjury, and the buyer certifies they received a copy.
Do all co-owners have to sign the VSA 5?+
No. The DMV's guide says that if several people are listed as sellers or buyers, only one seller and one buyer have to sign a VSA 5.
Which vehicles are exempt from odometer disclosure in Virginia?+
Under 49 CFR 580.17: model year 2010 and older; model year 2011 and newer once 20 years have passed since January 1 of the model year; vehicles over 16,000 lbs GVWR; and vehicles that aren't self-propelled. Virginia also honors another state's exemption shown on that state's title, which is what the VSA 5's fourth box is for, but the DMV still records the reading.
How long do Virginia dealers keep odometer statements?+
Five years, under 49 CFR 580.8: a copy of every odometer statement the dealer issues or receives. Electronic copies count if they can't be altered without detection.
Is there software that fills out the VSA 5 automatically?+
Yes. The Virginia VSA 5 is a fillable PDF, so dealer management software like DealerVLO can fill it for you: upload the blank form once, DealerVLO detects its fields and suggests a mapping you confirm, and from then on it fills from every deal you enter — the buyer, co-buyer, the vehicle you sold, and your dealership's details already in place. It's $29/month flat with a 14-day free trial, and the same deal also generates your federal documents (Bill of Sale, FTC Buyers Guide, odometer disclosure) and your state title paperwork.
- How to fill out the Virginia VSA 17A
- Odometer disclosure statements by state
- How to get a used car dealer license in Virginia
- Virginia dealer plates
- Title application forms in every state
- E-signatures and e-titling for Virginia dealers
- Virginia rebuilt vehicle disclosure (VSA 59)
- How much is a dealer's license? Cost in every state
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