Form 130 Fillable Request for Certification of Tax Filings
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Adjusted Gross Income (AGI) Dollar amount of REFUND or BALANCE DUE Filing Status Number of Exemptions (A o tributario) (A o tributario) (A o(s) Tributario) (Apellido) (C digo postal) (Calle) (checkbox) Unchecked (Ciudad) (Ciudad) (Direcci n de Correo electr nico) (Direcci n Postal Actual) (Estado) (Fecha) (ITIN/ N mero de Seguro Social) (N mero de tel fono) (No) Unchecked (Nombre del Contribuyente) (Nombre) (Si) Unchecked (Si) Unchecked (text) (text) (text) *** THIS FORM MUST BE SIGNED IN THE PRESENCE OF A REPRESENTATIVE OF THE *** 1 Did you file a Maryland tax return during one or both of the previous two years? 1 South Potomac Street 100 West Patrick Street 103 Chesapeake Blvd Suite D 1036 St Nicholas Dr Suite 202 110 Carroll St 11002 Veirs Mill Road Suite 408 130 and visit one of the Comptroller s twelve branch offices to 1306 South Salisbury Blvd Ste 182 14735 Main St Rm 083B 1a Name as shown on return(s) if different from above: 1b Mailing address as shown on return(s) if different from above: 3 Pershing St Ste 101 300 East Joppa Rd Ste PL 1A 301 W Preston St Rm 206 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 8181 Professional Pl Suite 101 a branch office You may schedule an appointment online at A photo ID and any 3 of the following 5 items from the most A photo ID and the original or copy of the ITIN letter from Administration Division Annapolis Annapolis MD 21411 0001 Applicant s Information application to MVA Approved as a dependent on another taxpayer s filing prior to making Baltimore Baltimore MD 21201 2384 below Offices are open Monday Friday 8:30 a m 4:30 p m BRANCH OFFICES card under 12 301 of the Transportation Article a moped Citizenship and Immigration Services documentation in order to City State ZIP code Tax year COM/RAD 035 COMPTROLLER OF MARYLAND Comptroller s Office The new name must match the name that the Control Number Assigned correct and complete Courthouse/Multiservice Center Cumberland Cumberland MD 21502 3042 Current mailing address Deduction Method i e Standard or Itemized and the Denied Did you file federal Form 4868 (Application for Automatic Extension of Time to File U S Do not sign Form 130 until you are instructed to do so by a documentation without valid accompanying United States dollar amount; or each of the preceding 2 years has filed a Maryland income Elkton Elkton MD 21921 6313 Email address FOR ADDITIONAL INFORMATION OR SPECIAL ASSISTANCE for individuals who have an existing Maryland driver s license or Frederick Frederick MD 21701 5646 Hagerstown Hagerstown MD 21740 5512 Hampton Plaza Highway Safety Act of 2013 And further I certify that to the best of my knowledge all information provided on this form is true htm for complete listing) the address from which the ID you must change your name with the IRS prior to coming to identification card If yes complete 1a and 1b If you have a different name on your ITIN letter from your photo If you have a different name on your Social Security Card from Individual Income Tax Return) or Maryland Form 502E (Maryland Application for Extension individual who does not have lawful status but requires that any INSTRUCTIONS issued such card permit or license by the MVA To obtain ITIN SSN Type of ITIN/SSN Tax year(s) Landover Landover MD 20785 2226 Last name Suffix First name M I license identification card or moped operators permit to an Maryland Relay Service (MRS) 711 MARYLAND REQUEST FOR CERTIFICATIONFORM MARYLAND REQUEST FOR CERTIFICATIONFORM Maryland to release the requested information to the Maryland Motor Vehicle Administration in accordance with the Maryland most recent year s tax return was filed and the ITIN or SSN must be submitted in person MUST match the name on the photo identification used to provide must provide documentary evidence that the applicant for Name of Taxpayer NOTE: The name on the Social Security Card or ITIN letter obtain a driver s license or identification card It is not required obtain a letter certifying proof of filing or that they were claimed OF TAX FILINGS INSTRUCTIONS of the Motor Vehicle Administration ( MVA ) to issue a driver s of the previous two years? If Yes complete 3a office of the Comptroller of Maryland Do not mail this form; it OFFICE USE ONLY operator s permit under 16 104 2 of the Transportation Article or a license to drive issued under the Transportation Article or call 410 260 7980 or toll free 800 638 2937 photo ID Please print in black or blue ink please visit http://www socialsecurity gov/ssnumber/) please visit www irs gov Prince George s County Courthouse Professional Arts Building PROOF OF IDENTIFICATION proof of identity Proof of identity acceptable to the MVA (see this link http:// PURPOSE OF FORM recent Maryland tax return: representative of the Comptroller of Maryland Revenue Revenue Administration Center Rm 2110 Salisbury Salisbury MD 21801 6846 Sea Gull Square Security Administration (SSA) prior to coming to the the Maryland SIGNATURE and VERIFICATION: I understand that taxpayer information is confidential and authorize the Comptroller of Signature of applicant SSA has on record (For information on Social Security Numbers State Office Building State ZIP code Applicant s ITIN or SSN Street such applicant who is not a current holder of an identification tax return or been claimed as a dependent by an individual Tax year Tax year(s) / Request: Telephone number the Comptroller of Maryland s office The new name must match The following proof of identification is required: the IRS or SSN card; or The Maryland Highway Safety Act of 2013 expands the authority the name that the IRS has on record For information on ITINs the required documentation applicants must complete Form This form is only required for immigrants presenting foreign This form must be filled out in its entirety and submitted in person to File Personal Income Tax Return) for the most recent tax year? Towson Towson MD 21286 3020 Treetops Building Upper Chesapeake Corporate Center Upper Marlboro Upper Marlboro MD 20772 9978 Visit our Web site at www marylandtaxes com Waldorf Waldorf MD 20603 4757 Were you claimed as a dependent on a Maryland tax return during one or both Westfield Wheaton South Building Wheaton Wheaton MD 20902 2574 WHERE TO SUBMIT FORM 130 who has filed a Maryland income tax return in order to be WHO MUST FILE with acceptable proof of identification (see below) to any branch www marylandtaxes com or by calling 410 260 7980 www mva maryland gov/driver services/Apply/sources ofproof You can submit Form 130 at any of the branch offices listed You must schedule an appointment to submit this form at your photo ID you must change your name with the Social