Maryland > Statewide > Motor Vehicle Administration
Certificate Of Facts Relative To Judgement ICD-022 - Maryland
| Certificate Of Facts Relative To Judgement Form. This is a Maryland form and can be used in Motor Vehicle Administration Statewide . |
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ICD-022 (05-03) Certificate of Facts Relative to Judgement (Sec., 17-202, Maryland Transportation Article, Vehicle Laws) Note: No action will be taken unless: (1) this judgement is a result of Motor Vehicle accident damages, (2) this form is completed in its entirety (including full name of the defendant(s), date of birth and/or driver's license number), (3) a certified copy of the judgement is attached, and (4) the judgement appeal period has expired. This is to certify that on in the Against: Full Name: Address: Driver's License Number: Reciprocity States to Notify: In Favor of: Name of Plaintiff(s): Address of Plaintiff(s): Date of motor vehicle accident: Signature: Name of Plaintiff's Attorney: Address of Plaintiff's Attorney: Telephone Number of Plaintiff's Attorney: Attorney Case #: Mail to: Insurance Compliance Division Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 With Certified Copy of Judgement Attached Court case number: Date: First Middle Last Date judgement was entered, from which no appeal has been taken, Court of Date of Birth: Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 For more information, please call: 1-800-638-8347 (touch tone calls only), 1-800-950-1MVA (1682) (to speak with a customer service representative), From Out-of-State: 1-301-729-4550, TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.marylandmva.com American LegalNet, Inc. www.FormsWorkFlow.com
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