Commissioner of the Revenue, Page 2 of 2
Jointly Owned Property: Personal property jointly owned with a spouse may also qualify for
exemption under the Military Spouses Residency Relief Act. The Act is effective for taxable year
2009 and thereafter. In order to qualify, please complete the following, if applicable
Service Member Spouse Name: __________________________________________________
Legal Residence Street Address: _________________________________________________
Legal Residence City/County, State: ______________________________________________
State to which State Income Tax is paid: ___________________________________________
Temporary Virginia Residence: ___________________________________________________
____________________________________________________________________________
List any jointly owned vehicles not included above:
Vehicle 1 Year, Make, Model: ____________________________________________________
Vehicle 2 Year, Make, Model: ____________________________________________________
Vehicle 3 Year, Make, Model: ____________________________________________________
Vehicle 4 Year, Make, Model: ____________________________________________________
I certify that the above information is all correct and that my legal residence is the street address
and state listed. It is my present intention to return to said place of legal residence at the
termination of my spouse’s military service. I am not a registered voter in Virginia nor do I file
Virginia income tax. I am temporarily in the State of Virginia solely to be with my spouse, who is
here in compliance with military orders, and request that my tangible personal property be
assessed in the state and city/county of my legal residence, as provided for in accordance with
the Service Member Civil Relief Act, 50 U.S.C. App. 571 Sec. 511. None of this personal
property is used for a trade or business. I have enclosed documentation showing my home of
record.
____________________________________________________________________________
Signature of Service Member Spouse
____________________________________________________________________________
Signature of Service Member
Commissioner of the Revenue Office Use Only; Date Received: _________________________
