Montgomery County
Commissioner of the Revenue
Helen P. Royal, Master Commissioner of the Revenue
Name:
SSN: Rank:
Branch of Service:
Legal Address:
City and State: Zip Code:
My Home of Record when entering the Military:
State:
I changed my domicile/legal residence to the state of:
Month, Day and Year of change: / /
My state income tax is paid to the State of:
I am a registered voter in that state: Yes or No
I have not registered to vote at any other place. Yes or No
The foregoing instrument was acknowledged before me this day of
Signature of Officer Administering Oath:
Please mail to: Montgomery County Commissioner of the Revenue
Helen P Royal, MCR
755 Roanoke St. Suite 1A
Christiansburg, VA 24073
CERTIFICATE OF LEGAL RESIDENCE
(Domicile)
www.MontVa.com • 540-382-5710 • Fax 540-381-6838 • personalproperty@montgomerycountyva.gov
This certificate must be filed by person claiming exemption from taxation in the state of Virginia under the
Soldiers' and Sailors' Civil Relief Act.
CHANGING HOME OF RECORD/LEGAL RESIDENT
.
Signature
(Attach current LES)
2021