Fillable CS-006 (07-17) Verication of Residency To be completed (State of Maryland)

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CS-006 (07-17) Verication of Residency To be completed (State of Maryland)

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CS-006 (07-17)
Verification of Residency To be completed by Dealer
Please type or print all information. This is to certify that the following person(s) has displayed evidence of residency at the
out-of-state address listed below. See reverse side for important instructions.
Name of Purchaser: ___________________________________________________________________________________________________
Address of Purchaser: _________________________________________________________________________________________________
Name of Co-Purchaser: _______________________________________________________________________________________________
Address of Co-Purchaser: _____________________________________________________________________________________________
Temporary Plate No. ______________ has been issued effective ______________ for a ______________ __________________________
Serial Number: ________________________________________________
Document Displayed: __________________________________________ ID No.: _______________________________________________
Driver’s License No.: ___________________________________________ State: ________________________________________________
Purchaser’s Signature __________________________________________ Date: _________________________________________________
Co-Purchaser’s Signature _______________________________________ Date: _________________________________________________
I certify under penalty of perjury, that the statements made herein are true and correct to the best of my knowledge, information and belief.
_____________________________________________________________________________________________________________________
Make
Date of Sale Year
Signature of Dealer or Authorized RepresentativeName of Dealer Dealer Number
White Copy - MVA Copy Canary Copy - Purchaser’s Copy Pink Copy - Dealer’s Copy
For more information visit our website at www.mva.maryland.gov or call 410-768-7000.
TTY for the hearing impaired: 1-800-492-4575.
6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062
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Dealer and Purchaser - Please Read Carefully
1. If this form is used in conjunction with the Temporary Registration Certificate (VR-007), the MVA
copy of this form is to be attached to the MVA copy of the Temporary Certificate and forwarded to
the Motor Vehicle Administration.
2. Actual evidence of out-of-state residency should be inspected by the dealer. A description of
the document presented by the purchaser, and any identifying numbers, must be recorded on
this form. If feasible, dealers should secure photocopies of documents for protection in the event
of a contested case.
3. Failure to comply with the above procedures and the making of a false certification is a misdemeanor
and may result in criminal prosecution and may also result in the suspension of the dealer’s privilege
to issue Temporary Registration Plates pursuant to Section 13-608 of the Transportation Article.
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CS-006 (07-17) Verication of Residency To be completed (State of Maryland)

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Completed 21 October 2020

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