DECLARATION FOR
LOCAL VEHICLE REGISTRATION FEE EXEMPTION
Please check the division that applies:
VOLUNTEER FIRE FIGHTER AND RESCUE SQUAD AUXILIARY POLICE
AUXILIARY DEPUTY SHERIFF VOLUNTEER POLICE CHAPLAINS
Complete and return to Chief of Fire Company, or Rescue Squad, or Chief of Police, or Sheriff for exemption of vehicle from the
Local Vehicle Registration Fee. This declaration will be valid until an amended declaration is filed. An amended declaration may be
filed for any vehicle exemption change or for any change to inactive status, or you may contact the Personal Property Taxpayers
Division of this office via telephone at 757.385.4487; via facsimile at 757.427.1802; or via electronic mail at
.
Original Declaration
Amended Declaration
Name __________________________________
Owner’s Social Security Number ________________________
Address ________________________________
Virginia Beach, VA (Zip) ______________________________
Phone Number __________________________
Email Address _______________________________________
Yes
Resident of Virginia Beach?
Resident of Another Locality? Yes
If yes, please indicate locality: ________________________________________
Non-Resident Military Personnel Please Send Copy of Leave and Earnings Statement “LES”.
VEHICLE DESCRIPTION
Make ___________________________________
Model _____________________________________________
Title Number _____________________________
License Plate Number _________________________________
VIN Number _____________________________
If vehicle is leased, please indicate lease company: ____________________________________________________________
PLEASE CHECK ONE:
In order to qualify for the exemption, I hereby agree to notify the Commissioner of the Revenue, immediately upon my
becoming an inactive volunteer prior to completing 10 or more years of service, in accord with the city ordinance.
I no longer qualify for an exemption, therefore I hereby notify the Commissioner of the Revenue of becoming an inactive
volunteer prior to completing 10 or more years of service, in accord with city ordinance.
Signature of Applicant ________________________________
Date ____________________________________
I hereby certify that the above named applicant is an active volunteer of the ___________________________ or is an inactive volunteer with
10 or more years of service. In accord with city ordinance, I hereby agree to notify the Commissioner of the Revenue, immediately of any
volunteer who becomes inactive and the length of active volunteer service.
Signature of Chief __________________________________
Date ____________________________________
For hearing or visually impaired assistance dial 711
rev. 01.08.14
1
