MVA Certified Statement / Receipt PDF Details

I certify under penalties of perjury, the statements made on this form are true and correct to the best of my knowledge, information and belief.

Items: MD Commercial Driver's License, MD Noncommercial Driver's License, MD Identification Card, Registration Plate(s) with Tag #, Disability Placard(s) #

Out-of-State Product: Please include state, type, expiration date and number, if available

Item was: Lost, Stolen (Police report # and Jurisdiction reported), Taken by Law Enforcement, Other (please explain), Turned in to the MVA today

Reason for Return: Suspended, Parental Consent Withdrawn, etc.

Case numbers: Investigation Case No. and Dept. of Origin Case No.

Signer: Print Name, Signature, Date and Relationship of person surrendering above item: (self, parent, law enforcement officer, etc.)

QuestionAnswer
Form Name MVA Certified Statement / Receipt
Form Length 1 page
Fillable? Yes
Fillable fields 21
Avg. time to fill out 4 min
Other names Form DL-304, Form MVA DL 202, MVA DL-202, Certified Statement / Receipt
Edition03-18
Official sourceForm DL-304 (03-18), Certified Statement / Receipt, Maryland Motor Vehicle Administration

How to Fill Out Form MVA DL 202

Form MVA DL 202 at a glance

What it is: Form DL-304 is a Certified Statement / Receipt: you certify that you no longer have in your possession, or are turning in today, the item checked on it.

Who signs: By signing, you certify under penalties of perjury that the statements made on this form are true and correct to the best of your knowledge, information and belief. Enter your Print Name, Signature and Date.

A filled-in Form MVA DL 202 example: a driver surrenders a stolen license

Form MVA DL 202 example filled out, example: a driver surrenders a stolen license
Dana Q. Sample surrenders a Maryland noncommercial driver's license on this form. It was stolen and reported to Baltimore City police, so nothing goes in the Lost, Taken, Other or Turned in boxes. The picture shows the filled form, and its names and figures are sample values.

How to fill out Form MVA DL 202, box by box

MD license, Identification Card, Registration Plate(s)

Form MVA DL 202 example filled out, mD license, Identification Card, Registration Plate(s)

Check MD Commercial Driver's License, MD Noncommercial Driver's License or MD Identification Card.

For an Out-of-State Product, check it and enter the state, type, expiration date and number, if available.

For Registration Plate(s), check it and enter the Tag #. For Disability Placard(s), check it and enter the #.

The document/plates checked above were

Form MVA DL 202 example filled out, the document/plates checked above were

Check Lost* or Stolen*. With Stolen*, enter the Police report # and the Jurisdiction reported.

Check Taken by Law Enforcement, or check Other and explain it on the line after Other (please explain).

Check Turned in to the MVA today and enter the Investigation Case No. and the Dept. of Origin Case No. Enter the Reason for Return (Suspended, Parental Consent Withdrawn, etc.).

Relationship of person surrendering the item

Form MVA DL 202 example filled out, relationship of person surrendering the item

Enter the Relationship of person surrendering the item (self, parent, law enforcement officer, etc.).

More rules for Form MVA DL 202

The FOR MVA USE ONLY section has lines for Driver License / ID Number, Issuing State, Class / Type, Date Issued, Expiration Date, Printed Name of MVA Agent, Signature and Branch/Office/Room Number.

The MVA is at 6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062. For more information visit www.mva.maryland.gov, call 410-768-7000 or TTY for the hearing impaired: 1-800-492-4575.

Sources

[1] Form DL-304 (03-18), Certified Statement / Receipt, Maryland Motor Vehicle Administration (the Official source link on this page).

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