Mva Form Icd 071 – Fill Out and Use This PDF

The MVA ICD 071 form is an official document issued by the Maryland Vehicle Administration that serves as a certified statement for the Vehicle Insurance Compliance Program. It collects the owner's information, statement of facts, and requires affirmations from witnesses concerning the vehicle's status during a lapse in insurance coverage, under penalty of perjury. Interested parties are encouraged to accurately complete and submit this form to avoid penalties and ensure compliance with Maryland's vehicle insurance laws.

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Mva Form Icd 071 PDF Details

Navigating the intricacies of vehicle insurance compliance within Maryland necessitates a thorough understanding of the specific documentation and forms required by the state. Among these, the Motor Vehicle Administration's ICD-071 form represents a crucial document for vehicle owners facing insurance lapse issues. Located at 6601 Ritchie Highway, N.E., Glen Burnie, Maryland, the Motor Vehicle Administration outlines through this form, part of the Maryland Vehicle Insurance Compliance Program, a structured process for owners to certify their vehicle's insurance status. The form facilitates a certified statement from the vehicle owner, detailing essential information such as case number, insurance cancellation date, insurance company info, and vehicle identification, including year, make, and model. This document is especially significant when a vehicle has not been driven, involved in an accident, or received a citation during the period of insurance lapse, detailing where the vehicle was parked alongside reasons for the insurance lapse. Validation by witnesses or repair facilities adds credibility to the owner's statement, culminating in a declaration under penalty of perjury that the information provided is accurate and truthful, thereby navigating the complexities of maintaining legal vehicle status within Maryland's regulatory framework.

Question	Answer
Form Name	Mva Form Icd 071
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	mva maryland icd 071, icds form, icd 071, form icd 071

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Motor Vehicle Administration

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

ICD-071 (12-13)

Maryland Vehicle Insurance Compliance Program – Certified Statement

Section 1: Owner’s Information and Statement of Facts

CASE NUMBER

INSURANCE CANCELLATION DATE

INSURANCE COMPANY

TAG NUMBER

TITLE NUMBER

VEHICLE IDENTIFICATION NUMBER:

YEAR:

MAKE:

VEHICLE OWNER (First, Last Name):

OWNER’S DRIVERS LICENSE NUMBER:

The vehicle listed above has not been driven, involved in an accident, or issued a citation during period of insurance lapse

	to		. During this time the vehicle was parked at
MM/DD/YY		MM/DD/YY

(Location)

(Street Address)

(CIty)

(State)

(Zip Code)

For the following reason(s):

(Supporting documentation attached)

I certify, under penalty of perjury, that the statements made above are true and correct to the best of my knowledge, information and belief, under Section 12-109 b (2) of the Maryland Vehicle Law.

Signature Owner/Co-Owner

Date

Daytime Telephone Number

Section 2: Witness Statement of Facts

Witness A or Repair Facility - Business License #

I certify, under penalty of perjury, that the statements made above by the vehicle owner are true and correct to the best of my knowledge, information and belief, under Section 12-109(b) of the Maryland Vehicle Law.

Signature Witness

Drivers License Number

Date

Daytime Phone Number

Witness B

	Witness Signature	Drivers License Number			Date		Daytime Phone Number

MVA Use Only
	Moving Violation/Accident	No q	Yes q	Date:_______________		Case/Ticket #:________________
	Prior Case:	No q	Yes q	Date:_______________		Case #:______________________
	Adjustment Approved:	No q	Yes q	Amount:_____________
Authorized By:_ ________________________________________					ID:_ _________________		Date:__________________

For more information, please call: 410-768-7000 (to speak with a customer agent).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov

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