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 MARYLAND   REQUEST FOR CERTIFICATION                                                       OFFICE USE ONLY
   FORM
            OF TAX FILINGS                                  Tax year(s)                                    Request:
                                                                                    /
  130                                                                                                              Approved
                                                            Control Number Assigned
                                                                                                                   Denied
                                                                                             Type of 
                                                            ITIN        SSN
Applicant’s Information                                                                      photo ID
Print using black or blue ink only.
Last name                                                   Suffix              First name                                                                           M.I.

Current mailing address

City                                                        State      ZIP code +4                   Applicant’s ITIN or SSN

1. Did you file a Maryland tax return during one or both of the previous two years? 
   If yes, complete 1a and 1b.      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   Yes     No

   1a.  Name as shown on return(s), if different from above:

      ___________________________________________                  __________________________
                                   Name                                            Tax year

      __________________________________________                   __________________________
                                   Name                                            Tax year
   1b.  Mailing address as shown on return(s), if different from above:

      ___________________________________________________________________________________________________
     Street                                        City                 State                ZIP code   +4                                                   Tax year

      ___________________________________________________________________________________________________
     Street                                        City                 State                ZIP code   +4                                                   Tax year

2.  Did you file federal Form 4868 (Application for Automatic Extension of Time to File U.S. 
   Individual Income Tax Return) or Maryland Form extension to file personal income tax return  
   for the most recent tax year?    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     Yes     No

3. Were you claimed as a dependent on a Maryland tax return during one or both 
   of the previous two years? If “Yes”, complete 3a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                Yes     No
   3a.  Name(s) and ITIN(s)/SSN(s) of taxpayer(s) claiming you as a dependent and tax year(s) you were claimed as a dependent.

      ______________________________________                 ________________________             ___________________
                       Name of Taxpayer                                ITIN/SSN                            Tax year(s)

      ______________________________________                 ________________________             ___________________
                       Name of Taxpayer                                ITIN/SSN                            Tax year(s)

            *** THIS FORM MUST BE SIGNED IN THE PRESENCE OF A REPRESENTATIVE OF THE ***  
                                              COMPTROLLER OF MARYLAND.

SIGNATURE and VERIFICATION:        I understand that taxpayer information is confidential and authorize the Comptroller of 
Maryland to release the requested information to the Maryland Motor Vehicle Administration in accordance with the Maryland 
Highway Safety Act of 2013. And further, I certify that to the best of my knowledge all information provided on this form is true, 
correct and complete.

       _________________________________________                   __________________________________________
                       Signature of applicant                                                Date

                                                                   __________________________________________
                        Telephone number                                                   Email address
COM/RAD-035 04/22

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MARYLAND REQUEST FOR CERTIFICATION
FORM
OF TAX FILINGS INSTRUCTIONS
130

WHO MUST FILE • A photo ID and any 3 of the following 5 items from the most
This form is only required for immigrants presenting foreign recent Maryland tax return:
documentation without valid accompanying United States - Adjusted Gross Income (AGI)
Citizenship and Immigration Services documentation in order to - Filing Status
obtain a driver’s license or identification card. It is not required - Number of Exemptions
for individuals who have an existing Maryland driver’s license or - Dollar amount of REFUND or BALANCE DUE
identification card.
- Deduction Method, i.e. Standard or Itemized, and the
PURPOSE OF FORM dollar amount; or,
The Maryland Highway Safety Act of 2013 expands the • Proof of identity acceptable to the Motor Vehicle
authority of the Motor Vehicle Administration (“MVA”) to issue Administration (MVA) (see this link https://mymva.
a driver’s license, identification card, or moped operators maryland.gov/go/web/OnlineDocumentGuide), the address
permit to an individual who does not have lawful status, but from which the most recent year’s tax return was filed, and
requires that any such applicant who is not a current holder the ITIN or SSN.
of an identification card under §12-301 of the Transportation
Article, a moped operator’s permit under §16-104.2 of the NOTE: The name on the Social Security Card or ITIN letter
Transportation Article, or a license to drive issued under the MUST match the name on the photo identification used to provide
Transportation Article, must provide documentary evidence proof of identity.
that the applicant, for each of the preceding 2 years, has filed If you have a different name on your Social Security Card from
a Maryland income tax return or been claimed as a dependent your photo ID, you must change your name with the Social
by an individual who has filed a Maryland income tax return in Security Administration (SSA) prior to coming to the the Maryland
order to be issued such card, permit or license by the MVA. To Comptroller’s Office. The new name must match the name that the
obtain the required documentation, applicants must complete SSA has on record. (For information on Social Security Numbers,
Form 130 and visit one of the Comptroller’s branch offices to please visit socialsecurity.gov/ssnumber/).
obtain a letter certifying proof of filing or that they were claimed If you have a different name on your ITIN letter from your photo
as a dependent on another taxpayer’s filing prior to making ID, you must change your name with the IRS prior to coming to
application to MVA. the Comptroller of Maryland’s office. The new name must match
INSTRUCTIONS the name that the IRS has on record. For information on ITINs
This form must be filled out in its entirety and submitted in person please visit irs.gov.
with acceptable proof of identification (see below) to any branch WHERE TO SUBMIT FORM 130
office of the Comptroller of Maryland. Do not mail this form; it
must be submitted in person. You can submit Form 130 at any of the branch offices listed
Do not sign Form 130 until you are instructed to do so by a below. Offices are open Monday – Friday, 8:30 a.m. - 4:30 p.m.
representative of the Comptroller of Maryland, Revenue You must schedule an appointment to submit this form at
Administration Division. a branch office. You may schedule an appointment online at
marylandtaxes.gov or by calling 410-260-7980.
PROOF OF IDENTIFICATION
The following proof of identification is required: FOR ADDITIONAL INFORMATION OR SPECIAL ASSISTANCE
• A photo ID and the original or copy of the ITIN letter from Visit our Web site at marylandtaxes.gov
the IRS or SSN card; or, or call 410-260-7980 or toll-free 800-638-2937.
Maryland Relay Service (MRS) . . . . . . . . . . . . . . . . . . . . . 711

BRANCH OFFICES
Annapolis Cumberland Salisbury
Revenue Administration Division 3 Pershing St., Ste 101 Sea Gull Square
110 Carroll St. Cumberland, MD 21502-3042 1306 South Salisbury Blvd., Unit 182
Annapolis, MD 21411-0001 Elkton Salisbury, MD 21801-6846
Baltimore Upper Chesapeake Corporate Center Towson
We’re moving in early 2024! 103 Chesapeake Blvd., Suite D Hampton Plaza
Please confirm location prior to Elkton, MD 21921-6391 300 East Joppa Rd., Ste. Plaza Level 1-A
your visit by calling 1-800-638-2937. Frederick Towson, MD 21286-3020
Courthouse/Multiservice Center Waldorf
• State Office Building 100 West Patrick Street, Rm. 2603 1036 St. Nicholas Dr., Unit 202
301 W. Preston Street, Room 206 Frederick, MD 21701-5578 Waldorf, MD 20603-4760
Baltimore, MD 21201-2326
Greenbelt Wheaton
• New office Triangle Centre Westfield Wheaton South Building
7 St. Paul Street 6401 Golden Triangle Drive, Suite 100 11002 Veirs Mill Road, Suite 408
Ground Floor Greenbelt, MD 20770-3201 Wheaton, MD 20902-5919
Baltimore, MD 21202 Hagerstown
Crystal Building
1850 Dual Hwy., Suite 201
Hagerstown, MD 21740-6686

COM/RAD-035 Rev 08/23

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