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Motor Vehicle Administration 6601 Ritchie Highway N.E. Glen Burnie Maryland 21062 VR-111 11-12 Application for Nonresident Permit Fees are nonrefundable Please complete this form in its entirety. Original Issuance Duplicates 27. 00 Approved by Permit 10. 00 Date Exp* Date Have you ever been issued a previous Maryland Nonresident Permit If yes please furnish the sticker number Vehicle Owner and issuance date Vehicle Operator First Name Middle Last Permanent Domicile Address City Yes No County Temporary Maryland Address State Year Policy/Binder Name of Insurance Company Vehicle ID Number Zip Code Operator s License No* State of Issuance Make Body Tag Number Student Military Temp* Employee Visitor Name of School Base or Employer Applicant Phone Number Address of Employer Length of Time Reason for Visit - Insurance I certify under penalty of perjury that the vehicle described above is insured by at least the minimum amount required by Maryland Motor Vehicle Laws and that this vehicle will be continuously insured throughout its registration period. I further certify that I am not a Maryland resident and that the statements made herein are true and correct to the best of my knowledge information and belief* Signature of Applicant For more information please call 410-768-7000 to speak with a customer service representative. TTY for the hearing impaired 1-800-492-4575. Visit our website at www. MVA. Maryland. gov Instructions Please complete the application in its entirety and submit with the following Photocopy of valid out-of-state driver s license. Copy of your current vehicle registration card. Student - Copy of your current student ID card or registration receipt indicating current enrollment. Military Personnel - Copy of your current military ID or verification from commanding officer. T emporary Employment - A letter from your employer on their company letterhead indicating the length of your anticipated employment in Maryland. Visitor - A written statement indicating the reason and length of stay in Maryland. Note This permit does not replace your home state s vehicle registration* A copy of this application must be kept with the registration of the vehicle. Apply to register to vote with your driver s license transaction* For details ask your customer service representative. Original Issuance Duplicates 27. 00 Approved by Permit 10. 00 Date Exp* Date Have you ever been issued a previous Maryland Nonresident Permit If yes please furnish the sticker number Vehicle Owner and issuance date Vehicle Operator First Name Middle Last Permanent Domicile Address City Yes No County Temporary Maryland Address State Year Policy/Binder Name of Insurance Company Vehicle ID Number Zip Code Operator s License No* State of Issuance Make Body Tag Number Student Military Temp* Employee Visitor Name of School Base or Employer Applicant Phone Number Address of Employer Length of Time Reason for Visit - Insurance I certify under penalty of perjury that the vehicle described above is insured by at least the minimum amount required by Maryland Motor Vehicle Laws and that this vehicle will be continuously insured throughout its registration period. I further certify that I am not a Maryland resident and that the statements made herein are true and correct to the best of my knowledge information and belief* Signature of Applicant For more information please call 410-768-7000 to speak with a customer service representative.