Judgement Default Notice
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Judgement Default Notice Form. This is a Maryland form and can be use in Motor Vehicle Administration Statewide.
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Tags: Judgement Default Notice, ICD-039, Maryland Statewide, Motor Vehicle Administration
ICD-039 (05-03)
(Sec., 17-209, Maryland Transportation Article,
Vehicle Laws)
Judgement Default Notice
The judgement debtor named below has defaulted in payments as specified by the Court Order of
Installment and Judgement previously filed with the Motor Vehicle Administration in favor of:
Name of Plaintiff(s):
Court judgement entered in:
Court case #:
Against the following Judgement Debtor:
Full Name:
First
Middle
Last
Date of Birth:
Address:
Driver’s License Number:
Reciprocity
States to Notify:
Accident Date:
ICD Case Number:
Signature of Plaintiff’s Attorney:
Date:
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
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
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