Judgement Default Notice {ICD-039}

Motor Ritchie Highway, N.E. 6601 Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062 Glen Burnie, Maryland 21062 Motor Vehicle Administration ICD-039 (01-04) ICD-039 (06-13) (Sec., 17-209, Maryland Transportation Article, Vehicle Laws) Vehicle Laws) Judgment Default Notice JudgmentDefault Notice (Sec., 17-209, Maryland Transportation Article, The Judgment debtor named below has defaulted in payments as specified by the Court Order of Installment and Judgment previously filed with the Motor Vehicle Administration in favor of: Name of Plaintiff(s): Court Judgment entered in: Court case #: Against the following Judgment Debtor: Full Name: 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., Room 140 Glen Burnie, Maryland 21062 First Middle Last 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 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), American LegalNet, Inc. From Out-of-State: 1-301-729-4550, TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.marylandmva.com www.FormsWorkFlow.com