Certificate Of Facts Relative To Judgement
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Certificate Of Facts Relative To Judgement Form. This is a Maryland form and can be use in Motor Vehicle Administration Statewide.
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Tags: Certificate Of Facts Relative To Judgement, ICD-022, Maryland Statewide, Motor Vehicle Administration
ICD-022 (05-03)
(Sec., 17-202, Maryland Transportation Article,
Vehicle Laws)
Certificate of Facts Relative to Judgement
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
Date
in the
judgement was entered, from which no appeal has been taken,
Court of
Against:
Full Name:
First
Middle
Last
Date of Birth:
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:
Court case number:
Date:
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
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
