reg 2016 001 - PPRATitle: reg 2016 001.tif Created Date: 6/29/2017 7:01:11 AM
DMV REG. EXP. DATE BRANCH LOCATION PROCESSING DATE … · CERTIFICATION AND SIGNATURE NAME REFUND...
1
CERTIFICATION AND SIGNATURE NAME REFUND AMOUNT $ REG. EXP. DATE BRANCH LOCATION PROCESSING DATE APPLICATION FOR ONE YEAR REFUND ON TWO YEAR REGISTRATION F-82 REV. 01-2020 NAME (Last, First, Middle Initial) DMV OFFICE USE ONLY you must complete and include an official B-58 Change of Address/Voter Registration application form. 1. 2. By submitting this form, I certify that I have cancelled my registration or authorize DMV to cancel my registration. I request a refund, as provided by law in Section 14-49(aa) of the Connecticut General Statutes. I understand that this refund will be mailed to the registration owner's address that is on file at the DMV. I hereby certify, under penalty of false statement, that all information above is true and accurate to the best of my knowledge and belief. SIGNATURE OF VEHICLE OWNER OR LESSEE X DATE SIGNED YES NO IS VEHICLE LEASED? STATE OF CONNECTICUT DEPARTMENT OF MOTOR VEHICLES SPECIALIZED REGISTRY SERVICES 60 STATE STREET, WETHERSFIELD, CT 06161-1022 On The Web At ct.gov/dmv INSTRUCTIONS: I AUTHORIZE DMV TO CANCEL MY REGISTRATION MY REGISTRATION HAS BEEN CANCELLED VEHICLE OWNER VEHICLE INFORMATION REGISTRATION (PLATE) NUMBER REGISTRATION STATUS DISTRIBUTION: WHITE - DMV FILE COPY CANARY - DMV ACCOUNTING COPY A refund will be issued if, from the date of cancellation you have at least: a) one full year remaining on a two year registration, or b) one - two years remaining on a three year registration All refund applications must be submitted prior to the expiration of the registration period. The refund is only for the registration fee. If you have not cancelled your registration; DMV will cancel your registration and process the refund. This refund will be mailed to the address of record on the motor vehicle registration. If you want the refund mailed to a different address,
Transcript of DMV REG. EXP. DATE BRANCH LOCATION PROCESSING DATE … · CERTIFICATION AND SIGNATURE NAME REFUND...
CERTIFICATION ANDSIGNATURE
NAME REFUND AMOUNT
$REG. EXP. DATE BRANCH LOCATION PROCESSING DATE
APPLICATION FOR ONE YEAR REFUNDON TWO YEAR REGISTRATIONF-82 REV. 01-2020
NAME (Last, First, Middle Initial)
DMVOFFICE
USE ONLY
you must complete and include an official B-58 Change of Address/Voter Registration application form.
�
1.
2.
By submitting this form, I certify that I have cancelled my registration or authorize DMV to cancel ma refund, as provided by law in Section 14-49(aa) of the Connecticut General Statutes. I understabe mailed to the registration owner's address that is on file at the DMV. I hereby certify, under pethat all information above is true and accurate to the best of my knowledge and belief.
SIGNATURE OF VEHICLE OWNER OR LESSEE
X
YES NOIS VEHICLE LEASED?
STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLES
SPECIALIZED REGISTRY SERVICES60 STATE STREET, WETHERSFIELD, CT 06161-1022
On The Web At ct.gov/dmvINSTRUCTIONS:
I AUTHORIZE DMV TO CANCEMY REGISTRATION HAS BEEN CANCELLED
VEHICLE OWNER
VEHICLE INFORMATION
REGISTRATION (PLATE) NUMBER
REGISTRATION STATUS
DISTRIBUTION: WHITE - DMV FILE COPY CANARY - DMV ACCOUNTING COPY
A refund will be issued if, from the date of cancellation you have at least: a) one full year remaining on a two year registration, orb) one - two years remaining on a three year registrationAll refund applications must be submitted prior to the expiration of the registration period. The refund is only for the registration fee. If you have not cancelled your registration; DMV will cancel your registration and process the refund.
This refund will be mailed to the address of record on the motor vehicle registration. If you want the refund mailed to a different address,
y registration. I request nd that this refund will nalty of false statement,
DATE SIGNED
L MY REGISTRATION
