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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 authority • Proof of identity acceptable to the MVA
of the Motor Vehicle Administration (“MVA”) to issue a driver’s (https://mymva.maryland.gov/go/web/OnlineDocumentGuide),
license, identification card, or moped operators permit to an the address from which the most recent year’s tax return
individual who does not have lawful status, but requires that any was filed, and the ITIN or SSN.
such applicant who is not a current holder of an identification
card under §12-301 of the Transportation Article, a moped NOTE: The name on the Social Security Card or ITIN letter MUST
operator’s permit under §16-104.2 of the Transportation Article, match the name on the photo identification used to provide proof
or a license to drive issued under the Transportation Article, of identity.
must provide documentary evidence that the applicant, for If you have a different name on your Social Security Card from
each of the preceding 2 years, has filed a Maryland income your photo ID, you must change your name with the Social
tax return or been claimed as a dependent by an individual Security Administration (SSA) prior to coming to the Maryland
who has filed a Maryland income tax return in order to be Comptroller’s Office. The new name must match the name that the
issued such card, permit or license by the MVA. To obtain SSA has on record. For information on Social Security Numbers,
the required documentation, applicants must complete Form visit http://www.socialsecurity.gov/ssnumber/.
130 and visit one of the Comptroller’s twelve branch offices to
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
the name that the IRS has on record. For information on ITINs
INSTRUCTIONS visit www.irs.gov.
This form must be filled out in its entirety and submitted in person
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 You can submit Form 130 at any of the branch offices listed
must be submitted in person. below. Offices are open Monday – Friday, 8:30 a.m. - 4:30 p.m.
Do not sign Form 130 until you are instructed to do so by a You must schedule an appointment to submit this form at
representative of the Comptroller of Maryland, Revenue a branch office. You may schedule an appointment online at
Administration Division. www.marylandtaxes.gov or by calling 410-260-7980.
PROOF OF IDENTIFICATION FOR ADDITIONAL INFORMATION OR SPECIAL ASSISTANCE
The following proof of identification is required: Visit www.marylandtaxes.gov
• A photo ID and the original or copy of the ITIN letter from or call 410-260-7980 or toll-free 800-638-2937.
the IRS or SSN card; or, Maryland Relay Service (MRS) . . . . . . . . . . . . . . . . . . . . . 711

BRANCH OFFICES
Annapolis Frederick Towson
60 West Street Courthouse/Multiservice Center Hampton Plaza
Suite 102 100 West Patrick Street, Rm. 2603 300 East Joppa Rd., Ste. Plaza Level 1-A
Annapolis, MD 21404-2434 Frederick, MD 21701-5578 Towson, MD 21286-3020
Baltimore Greenbelt Upper Marlboro
State Office Building Triangle Centre Prince George’s County Courthouse
301 W. Preston St., Rm. 206 6401 Golden Triangle Drive, Suite 100 14735 Main St., Rm. 083B
Baltimore, MD 21201-2326 Greenbelt, MD 20770-3201 Upper Marlboro, MD 20772-3051
Cumberland Hagerstown Waldorf
3 Pershing St., Ste 101 Crystal Building 1036 St. Nicholas Dr., Unit 202
Cumberland, MD 21502-3042 1850 Dual Hwy., Suite 201 Waldorf, MD 20603-4760
Elkton Hagerstown, MD 21740-6686 Wheaton
Upper Chesapeake Corporate Center Salisbury Westfield Wheaton South Building
103 Chesapeake Blvd., Suite D Sea Gull Square 11002 Veirs Mill Road, Suite 408
Elkton, MD 21921-6391 1306 South Salisbury Blvd., Unit 182 Wheaton, MD 20902-5919
Salisbury, MD 21801-6846

COM/RAD-035 04/22

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