Mva Is 109 Form PDF Details

Are you a driver in the state of Virginia and wondering what an MVa Is 109 form is? If so, then this blog post is for you! We’re here to break down the contents of the form, as well as explain why it’s important. The MVa Is 109 is used by drivers in certain circumstances to report information to the Virginia Department of Motor Vehicles (DMV). So if you’re filling out your DMV paperwork or preparing for your road test and have come across one, it pays off to understand what it means. Read on below for more information about the form including when you need fill it out, how much time do you have until completion and other tips along with resources provided at authorized locations.

QuestionAnswer
Form NameMva Is 109 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmva investigative, form md 109, maryland motor complaint, form is109

Form Preview Example

MOTOR VEHICLE ADMINISTRATION

6601 Ritchie Highway, N.E.IS-109 (12-13) Glen Burnie, Maryland 21062

Investigative Division Complaint Report

Type of complaint: q Unlicensed Sales q Dealer Complaint q Foreign Registration q General Complaint

Person Making Complaint

Your Name: ________________________________________________________________________________________ Date:_______________________

Address:_______________________________________________________________________________________________________________________

City: ____________________________________________________________ State: ____________________________ Zip Code: __________________

Phone (Home): _______________________________Phone (Business):________________________________ Other (cell): _______________________

Signed: _______________________________________________________________________________________________________________________

I certify under penalty of perjury that the information contained herein is true and correct to the best of my knowledge, information, and belief.

Subject of Complaint

Subject’s Name: __________________________________________________ Phone #: _____________________________________________________

Address:_______________________________________________________________________________________________________________________

City: _____________________________________________________________ State: ________ Zip Code: ___________ Placard #_________________

Vehicles Involved: Year ___________________ Make ____________ Color ________________ Tag # _________________________________________

Year_________________Make______________________Model _________________ Color __________________ Tag # __________________________

Place of Employment for Subject (if known): _______________________________________________________________________________________

Time of day/night when subject is mostly at home or work (if know): __________________________________________________________________

Additional Comments:___________________________________________________________________________________________________________

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Additional Information On Complaint

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Use Back Of Form

MVA USE ONLY

Complaint received by: Agent/Employee: __________________________________________________________________________________________

Complaint Forwarded To: _________________________________________________Date Forwarded:________________________________________

Action Taken (Remarks, Forwarded to, Conclusion Reached, Etc):

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Signature: _______________________________________________________ Title:_____________________________ 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

Additional Information

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Apply to... Apply to register to vote with your driver’s license transaction. For details ask your customer service representative.

to Vote Now!

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Filling out section 1 in mva 109 form

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Stage # 2 for filling out mva 109 form

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Additional Information, Additional Information, and Additional Information of mva 109 form

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Part number 4 for completing mva 109 form

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Filling out section 5 of mva 109 form

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