M aryland Record Restriction Notice ○ ○ ○ ○ ○ ○ ○ Section A Name (please print) Date of Birth Driver’s License Number Section B 1. Ì I want my driver and motor vehicle records open to public access. 2. Ì I do not want my driver record or motor vehicle records open to public access. Signature (required) Date *Completed form must contain your signature. ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Please see back of this form for additional information. ○ 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, TDD for the hearing impaired: 1-800-492-4575. Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 DL-026 (3-00) American LegalNet, Inc. www.FormsWorkFlow.com ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Effective July 1, 2000 federal and state privacy laws prohibit the disclosure, except in certain circumstances, of Motor Vehicle Administration (MVA) records containing personal information without written permission from the individual who is the subject of the record. To make your MVA records public, complete Sections A and B, #1 of this form. Return the completed form to a MVA office or mail to: Motor Vehicle Administration, 6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062, Attn. Driver Records Unit. If you provided a written request to make your MVA records public after July 1, 2000 and now want the records private, complete Sections A and B, #2 of this form. Return the completed form to a MVA office or mail to: Motor Vehicle Administration, 6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062, Attn. Driver Records Unit. ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Maryland Record Restriction Notice American LegalNet, Inc. www.FormsWorkFlow.com