Mva Online Form – Fill Out and Use This PDF

Certiied Statement / Receipt

Maryland law requires customers to return their license plates to the MVA when the vehicle’s insurance is cancelled; when the customer moves out of Maryland; or when the license plates are no longer needed. Customers reporting license plates lost or stolen, should do so by providing a police report or police report number.

By completing the form as a vehicle owner, you are not released of any obligation required by Maryland Vehicle Law, including the requirement to maintain insurance, and follow up with jurisdictions in regard to registration plates and/or disability placards. In the event the registration plate(s) or disability placard becomes available, they must be returned to the Administration.

Check applicable box:

I certify: Registration Plate(s), Disability Placard, or Moped Motor-Scooter Decal for the vehicle identiied below was:

Lost (Police Report #)_____________________________________	Jurisdiction Reported ______________________________	Date of Loss_______________________
Stolen (Police Report #) ___________________________________	Jurisdiction Reported ______________________________	Date Stolen _______________________
Coniscated by Law Enforcement (attach proof) __________________________________________________ Date Coniscated		__________________________________
Investigation Case No. ____________________________________	Dept. of Origin Case No. ___________________________	Date______________________________

Repossessed (attach proof) _______________________________ Repossession title issued? Yes/No __________ Date of Repossession_______________________

Other (please explain and provide proof) ___________________________________________________________________________________________________________

Owner’s Street Address

City/County

State

Zip Code

I/we certify, under penalty of perjury that the above is true and correct to the best of my knowledge and belief. I also acknowledge that by completing this form, I am not released of any obligation as a vehicle owner required by Maryland Vehicle Law, including the requirement to maintain insurance, and follow up with any jurisdiction with regard to registration plates and/or placard.

Owner’s Signature _____________________________________________ Date ____________________ Co-owner’s Signature_____________________________________ Date ____________________

Send completed original form to MVA, Vehicle Records Division, Room 202, 6601 Ritchie Hwy, Glen Burnie, MD 21062, along with a copy of the valid state issued identiication(s) of the vehicle owner(s).

For MVA Use only  Copy of I.D. attached

Printed Name of MVA Agent

Signature

Branch/Ofice/Room Number

Substitute Plate/Placard/Decal issued

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