. . STATE OF MARYLAND MOTOR VEHICLE ADMINISTRATION INTERNATIONAL REGISTRATION PLAN CHANGE OF ADDRESS
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REGISTRANT INFORMATION
. ACCOUNT NUMBER . * Mandatory Fields . FLEET NUMBER
. * . .
. PREVIOUS ADDRESS
. *
. NAME OF REGISTRANT
. BUSINESS ADDRESS
. CITY

MAILING ADDRESS
STATE
ZIP CODE
Enter Zip as 99999 or 999999999
. CITY . STATE . . ZIP CODE .
. NEW ADDRESS
. BUSINESS ADDRESS
. CITY

MAILING ADDRESS
STATE
ZIP CODE
Enter Zip as 99999 or 999999999
. CITY . STATE . . ZIP CODE .
. PERSON TO CONTACT REGARDING APPLICATION
. * . NAME .
. CITY . . STATE .
. * . PHONE NUMBER . . Enter numbers only
. E-MAIL ADDRESS .
. I certify and affirm that the information submitted in this Change of Address are my own. I understand that it is unlawful to knowingly submit false information to the Motor Vehicle Administration, punishable by a fine of not more than $500 or imprisonment for not more than 2 months under sec. 27-101(c)(12) of the Motor Vehicle Law.
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