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2. The State Code of Virginia and ordinance of the City of Newport News provide that veterans who have been rated by the United States Department of Veteran affairs, or its successor agency, pursuant to federal law, to have a one hundred (100) percent service-connected total and permanent disability for exemption of one motor vehicle owned and used personally by the veteran as provided by Section 40-7.06 of the City Code.
4. Veteran Information
6. Disabled Veteran's Name*
8. Spouse of Veteran Name*
10. Account # / Tax Year*
12. Address*
14. City
15. State
16. ZIP*
18. Phone Number*
19. Email Address
21. Vehicle Information - Vehicle Primarily Used by or for the Veteran
23. Make*
25. Model*
27. Year*
29. Benefits Summary Letter*
    Benefits Summary Letter Required
31. Spouse (Military Dependent) ID
    Spouse (Military Dependent) ID Required (If Married)
33. Subject to the penalty prescribed by Virginia Code §58.1-11, I certify that the information contained on this form is complete and accurate. By typing my name below I certify that the information provided is accurate to the best of my knowledge and is in regards to the vehicle listed above that I own.
35. First Name*
36. Last Name*
37. Date*
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field