AFFIDAVIT
I
attest I am the spouse of
, an active
duty military member with legal residence other than Virginia, who is in Virginia in compliance with military
orders, and I am in Virginia solely to be with my spouse. Pursuant to the Service members Civil Relief Act, as
amended by the Military Spouses Residency Relief Act, I declare the same legal state of residence in the state of
________, as my military spouse. My military spouse’s Leave and Earnings Statement indicating an out of state
legal residence is attached for the tax year ______. I further affirm that I am the owner/co-owner of the following
vehicle(s):
YEAR
MAKE
MODEL
VA TITLE NUMBER
YEAR
MAKE
MODEL
VA TITLE NUMBER
I understand that if I am a registered voter in the State of Virginia, I cannot claim legal residency in
another state. I understand that I am required to submit an affidavit declaring my residency with my spouse’s
LES each year. I further understand that additional documentation may be required to confirm my legal
residence. I can be contacted via phone or email at _____________________________________________.
_________________________________________
Taxpayer – Legal Affiant
___________________
Date
Deputy Commissioner of the Revenue
- OR-
City/County of_________________
Commonwealth of Virginia
The foregoing instrument was acknowledged before me this ___ day of ___, 20 _____ by
__________________________________
(Name of person seeking acknowledgment)
______________________________________________
Notary Public
Notary registration number:__________________________
My commission expires: _______________________________
For hearing or visually impaired assistance, dial 711
rev. 01.06.15