What is the purpose of the VSA 10A form?

The VSA 10A certifies that an immediate family member of a fallen service member is eligible for Virginia’s Gold Star or Next of Kin license plate.

Do I need to pay a fee for the special plate?

No. The Gold Star and Next of Kin plates are issued free of charge to eligible families.

Can I submit the form electronically?

Virginia DMV still requires a printed, signed copy with supporting documents. The online filler only speeds up data entry.

What documents must I include with the VSA 10A?

A certified death certificate, proof of relationship (e.g., birth or marriage certificate), and the service member’s DD‑214 or equivalent military record.

How long does it take to receive the plate after submission?

Processing usually takes 7‑10 business days once a complete application reaches the DMV.

Can I apply for a Gold Star plate if the service member died outside the U.S.?

Yes, as long as the death occurred while the service member was on active duty and you can provide official documentation.

Is the VSA 10A form available in other languages?

The official form is only provided in English by the Virginia DMV.

Virginia VSA 10A – Gold Star / Next of Kin License Plate Certification

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Virginia VSA 10A – Gold Star / Next of Kin License Plate Certification

The VSA 10A is the official Virginia Department of Motor Vehicles (DMV) form used by immediate family members of military personnel who have died in service to request a special Gold Star or Next of Kin license plate. This commemorative plate honors the sacrifice of the fallen service member and provides a visible tribute on the road.

What Is the VSA 10A Form?

The VSA 10A, titled “License Plate Applicant Certification,” collects the applicant’s information, the deceased service member’s details, and a certification that the applicant is an immediate family member. Once approved, the DMV issues a Gold Star or Next of Kin plate at no additional cost.

Who Is Eligible?

Parents, spouses, children, or siblings of a service member who died while on active duty.
Legal guardians of a deceased service member.
Anyone who can provide official proof of relationship and the service member’s death.

How to Complete the Form Online

Instead of downloading the PDF and editing it manually, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load the fillable VSA 10A document directly in your browser, allowing you to type, sign, and save without any extra software.

Common Mistakes to Avoid

Leaving any required field blank – the DMV will reject incomplete submissions.
Misspelling the deceased service member’s name or rank.
Failing to attach supporting documents (military death certificate, proof of relationship).
Signing the form with a stylus that does not create a digital signature; use the built‑in signature field in Formize.

Where to Submit Your Application

After completing the form online, you have two options:

In‑person: Bring the printed, signed form and supporting documents to any Virginia DMV customer service center.
Mail: Send the completed form and copies of all required documents to:
Virginia Department of Motor Vehicles
Vehicle Registration Division
P.O. Box 27412
Richmond, VA 23269.

Processing typically takes 7‑10 business days once the DMV receives a complete application.

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FAQ

What is the purpose of the VSA 10A form?
The VSA 10A certifies that an immediate family member of a fallen service member is eligible for Virginia’s Gold Star or Next of Kin license plate.
Do I need to pay a fee for the special plate?
No. The Gold Star and Next of Kin plates are issued free of charge to eligible families.
Can I submit the form electronically?
Virginia DMV still requires a printed, signed copy with supporting documents. The online filler only speeds up data entry.
What documents must I include with the VSA 10A?
A certified death certificate, proof of relationship (e.g., birth or marriage certificate), and the service member’s DD‑214 or equivalent military record.
How long does it take to receive the plate after submission?
Processing usually takes 7‑10 business days once a complete application reaches the DMV.
Can I apply for a Gold Star plate if the service member died outside the U.S.?
Yes, as long as the death occurred while the service member was on active duty and you can provide official documentation.
Is the VSA 10A form available in other languages?
The official form is only provided in English by the Virginia DMV.

HOW TO

How to fill out VSA 10A for free, online in 5 easy steps:

1
Click the Fill‑out Button
On this page, click the bright “Fill out this form” button. The Formize PDF Filler will open the VSA 10A document directly in your browser.
2
Enter Your Information
Type your name, address, and the deceased service member’s details into the highlighted fields. Use the drop‑down menus where provided.
3
Add Your Digital Signature
Select the signature field, draw or type your signature using the Formize tools, and confirm.
4
Review & Save
Double‑check every entry for accuracy, then click “Save” to download a completed PDF copy for your records.
5
Submit to the DMV
Print the saved PDF, attach required supporting documents, and submit in person or by mail as described above.

ABOUT

Vehicle Registration Forms

If you own or lease a motor vehicle, trailer or boat, you must meet certain obligations to keep your vehicle legally registered and safe.

VSA 10A is one of Vehicle registration forms that are documents that are used to register a motor vehicle with the relevant state or provincial authority. These forms are typically required when a person purchases a new or used vehicle or when they move to a new state or province with a vehicle.

The exact requirements and forms needed for vehicle registration can vary by location, but generally, the process involves providing information about the vehicle, the owner, and any liens on the vehicle.

Once the registration forms and fees are submitted, the state or provincial authority will issue a registration certificate or license plate to the owner of the vehicle. This registration allows the vehicle to be legally operated on public roads and highways.

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