Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 UVA Email * Name * Department Name and Number * Phone Number * Delivery Address * Departmental Vehicle Number * Purchase Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Year, Make, Model * New or Used * New Used VIN # * Title # Body Type * Is this a Trailer, Low Speed Vehicle or Moped? * Color * Odometer Reading * Shipping Weight * G.V.W.R. * Axles * Proof of Ownership * Certificate of Origin Statement of Origin Title Dealer Number Dealer Processing Fee Sale Price * Fuel Type * Fuel Card Needed? * Yes No Planned Drop-off Date of Certificate of Origin/Title/Odometer Disclosure/Bill of Sale * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Have you informed the UVA Auto Insurance Program? * Yes No What WorkTag should be charged the $30 titling fee? * Leave this field blank