Unaltered inspection receipt 2014 95,001 +
Oil change or service repair receipt from a service station 2008 155,001 + 2015 85 001 +
Odometer certification certificate 2009 150,001 + 2016 70,001 +
2010 140,001 + 2017 60,001 +
Documentation must have VIN #
Applications received without proper documentation cannot be accepted or
The owner(s) must sign and date this form. If the owner is an entity such as a trust, partnership, limited liability company, or
corporation, it must be signed by a member, partner, executive officer, or other person specifically authorized in writing by the
trust, partnership, limited liability company, or corporation to sign.
I declare, under penalty of perjury, (1) that the foregoing information is complete, true and correct to the best of my knowledge and belief,
and (2) that I am the owner or a member, partner, executive officer, or other person specifically authorized in writing to sign.
The Commissioner of the Revenue may require the submission of additional information or other evidence deemed
necessary for a proper and equitable determination of the Application.
High Mileage Application MUST BE FILED EACH YEAR by May 1st to continue to receive a reduction.
Additional Owner Information
Complete, sign, date & return (to the address above) this High Mileage Application form and the required
documentation or evidence to support your application.
MONTGOMERY COUNTY, VIRGINIA
Helen P. Royal, Master Commissioner of the Revenue
755 Roanoke St. Suite 1A Christiansburg, VA 24073
Phone 540-382-5710 Fax 540-381-6838
You MUST attach a copy of one of the following documents.
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