Fillable Form Vr-461 Certified Statement / Receipt printable pdf download

Motor Vehicle Administration

VR-461 (10-13)

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

Certified Statement / Receipt

Maryland law requires customers to return their license plates to the MVA when the vehicle’s insurance is cancelled; when the customer moves out of Maryland; or

when the license plates are no longer needed. Customers reporting license plates lost or stolen, should do so by providing a police report or police report number.

By completing the form as a vehicle owner, you are not released of any obligation required by Maryland Vehicle Law, including the requirement to maintain

insurance, and follow up with jurisdictions in regard to registration plates and/or disability placards. In the event the registration plate(s) or disability placard

becomes available, they must be returned to the Administration.

Check applicable box:



I certify:

Registration Plate(s),

Disability Placard, or

Moped Motor-Scooter Decal for the vehicle identified below was:



Lost (Police Report #) _____________________________________ Jurisdiction Reported ______________________________ Date of Loss _______________________



Stolen (Police Report #) ___________________________________ Jurisdiction Reported ______________________________ Date Stolen _______________________



Confiscated by Law Enforcement (attach proof) __________________________________________________ Date Confiscated __________________________________



Investigation Case No. ____________________________________ Dept. of Origin Case No. ___________________________ Date ______________________________



Repossessed (attach proof) _______________________________ Repossession title issued? Yes/No __________ Date of Repossession _______________________



Other (please explain and provide proof) ___________________________________________________________________________________________________________

Plate #

Year

Make

Vehicle Identification #

Title #

# of Plates Returned

Placard #

Owner’s Driver’s License #

Owner’s Name

Co-Owner’s Driver’s License #

Co-Owner’s Name

Owner’s Street Address

City/County

State

Zip Code

I/we certify, under penalty of perjury that the above is true and correct to the best of my knowledge and belief. I also acknowledge that by completing this form, I am not released of any obligation as a

vehicle owner required by Maryland Vehicle Law, including the requirement to maintain insurance, and follow up with any jurisdiction with regard to registration plates and/or placard.

Owner’s Signature _____________________________________________

Date ____________________

Co-owner’s Signature _____________________________________

Date ____________________

Send completed original form to MVA, Vehicle Records Division, Room 202, 6601 Ritchie Hwy, Glen Burnie, MD 21062, along with a copy of the valid state issued identification(s) of the vehicle owner(s).



For MVA Use only

Copy of I.D. attached

Printed Name of MVA Agent

Signature

Branch/Office/Room Number

Substitute Plate/Placard/Decal issued

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: