ABANDONED MOTOR VEHICLE SALE … information owner of record vehicle information abandoned motor...
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SELLER INFORMATION OWNER OF RECORD VEHICLE INFORMATION ABANDONED MOTOR VEHICLE SALE NOTIFICATION H-110 REV. 3-2018 STATE OF CONNECTICUT DEPARTMENT OF MOTOR VEHICLES DEALERS AND REPAIRERS SECTION 60 STATE STREET, WETHERSFIELD, CT 06161 On The Web at ct.gov/dmv INSTRUCTIONS: 1. 2. 3. Print clearly or type. Attach H-110 to the Affidavit of Compliance (H-76). Mail copy to former owner of record. YEAR MAKE/MODEL ODOMETER READING COLOR VEHICLE IDENTIFICATION NUMBER APPROXIMATE VALUE OF VEHICLE $1500 OR LESS OVER $1500 NAME WAS NOTICE OF INTENT TO SELL SENT TO OWNER? YES NO ADDRESS NAME OF DEALER/REPAIRER ADDRESS OF DEALER/REPAIRER DATE VEHICLE PLACED IN CUSTODY OF DEALER/REPAIRER DEALER/REPAIRER LICENSE NUMBER STORAGE CHARGES (If any) TOWING CHARGES (If any) REPAIR CHARGES (If any) $ $ OTHER CHARGES (If any, specify) $ TOTAL OF ALL CHARGES $ LIEN INFORMATION NAME (Owner) ADDRESS DATE OF SALE PLACE OF SALE SALES PRICE $ PURCHASER(S) SIGNATURE OF SELLER X DATE SIGNED I have mailed this notification to the former owner of record identified above and have complied with all relevant legal requirements. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, under penalty of false statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the above cited laws.
Transcript of ABANDONED MOTOR VEHICLE SALE … information owner of record vehicle information abandoned motor...
SELLERINFORMATION
OWNER OFRECORD
VEHICLEINFORMATION
ABANDONED MOTOR VEHICLE SALE NOTIFICATIONH-110 REV. 3-2018
STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS SECTION60 STATE STREET, WETHERSFIELD, CT 06161
On The Web at ct.gov/dmvINSTRUCTIONS:1.2.3.
Print clearly or type.Attach H-110 to the Affidavit of Compliance (H-76).Mail copy to former owner of record.
YEAR MAKE/MODEL ODOMETER READING COLOR
VEHICLE IDENTIFICATION NUMBER APPROXIMATE VALUE OF VEHICLE
$1500 OR LESS OVER $1500NAME WAS NOTICE OF INTENT TO SELL SENT TO OWNER?
YES NOADDRESS
NAME OF DEALER/REPAIRER
ADDRESS OF DEALER/REPAIRER
DATE VEHICLE PLACED IN CUSTODY OF DEALER/REPAIRER DEALER/REPAIRER LICENSE NUMBER
STORAGE CHARGES (If any) TOWING CHARGES (If any) REPAIR CHARGES (If any)
$ $OTHER CHARGES (If any, specify)
$TOTAL OF ALL CHARGES
$
LIENINFORMATION
NAME (Owner)
ADDRESS
DATE OF SALE PLACE OF SALE SALES PRICE
$
PURCHASER(S)
SIGNATURE OF SELLER
X
DATE SIGNEDI have mailed this notification to the former owner of record identified above and have compliedwith all relevant legal requirements. The information provided to the Commissioner of MotorVehicles herein is subscribed by me, under penalty of false statement, in accordance with theprovisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understandthat if I make a statement which I do not believe to be true, with the intent to mislead theCommissioner, I will be subject to prosecution under the above cited laws.
