Form H-13B Connecticut Registration and Title Application - Connecticut

Form H-13B is a Connecticut Department of Motor Vehicles form also known as the "Connecticut Registration And Title Application". The latest edition of the form was released in June 1, 2018 and is available for digital filing.

Download an up-to-date Form H-13B in PDF-format down below or look it up on the Connecticut Department of Motor Vehicles Forms website.

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CONNECTICUT REGISTRATION AND
STATE OF CONNECTICUT
TITLE APPLICATION
DMV USE ONLY - TEMPORARY PLATE NUMBER
DEPARTMENT OF MOTOR VEHICLES
H-13B REV. 6-2018
60 STATE STREET, WETHERSFIELD, CT 06161
INSTRUCTIONS:
http://www.ct.gov/dmv
DMV USE ONLY - PERMANENT PLATE NUMBER
(1)
Please print using a black or blue pen.
(2)
Fill out the applicable sections of this form.
(3)
Use the DMV website to check for all documents required to complete your transaction and for any outstanding compliance issues.
OWNER'S (APPLICANT'S) NAME (Last, First, Middle Initial)
OWNER'S BIRTHDATE
OWNER SECTION
1
(APPLICANT)
OWNER'S LICENSE OR ID NUMBER
STATE WHERE ISSUED SECRETARY OF STATE NO. (If Applicable)
PHONE NUMBER (Optional)
IF CO-OWNERSHIP (Check one)
CO-OWNER'S (CO-APPLICANT'S) NAME (Last, First, Middle Initial)
CO-OWNER'S BIRTHDATE
JOINT/OR -
Requires ONE
signature to transfer ownership
COMMON/AND -
Requires ALL
CO-OWNER'S LICENSE OR ID NUMBER
STATE WHERE ISSUED SECRETARY OF STATE NO. (If Applicable)
PHONE NUMBER (Optional)
signatures to transfer ownership
OWNER'S MAILING ADDRESS
(Number and Street, and Apartment No. if applicable)
(City or Town)
(State)
(Zip Code)
CT RESIDENT?
RESIDENT ADDRESS (If Different from Mailing Address - PO Box is NOT acceptable. Please include Apartment No. if applicable)
YES
NO
IF DIFFERENT FROM RESIDENT ADDRESS, INDICATE HERE
CHECK BOX IF RESIDENT ADDRESS IS WHERE
(Number and Street, Apartment No.)
(City or Town)
(State)
(Zip Code)
VEHICLE
MOST
FREQUENTLY
LEAVES
FROM,
RETURNS TO, OR REMAINS (For Property Tax)
VEHICLE I.D. NUMBER
YEAR
MAKE
MODEL NAME OR NO.
BODY STYLE (4-Dr. Sedan, etc.)
VEHICLE
2
INFORMATION
FUEL TYPE (Gas, Diesel, etc.)
CYLINDERS or CC's
NO. OF WHEELS
COLOR(S) (Maximum of Two)
ODOMETER READING (Mileage)
NEW OR USED?
If Commercial use,
Combination use or Pick-Up
NEW
USED
Truck Complete Section 8
NAME OF SELLER(S) (If 2 owners, include both names)
DATE VEHICLE SOLD (Purchased)
SELLING PRICE
SELLER'S
3
INFORMATION
SELLER'S ADDRESS (Number and Street)
(City or Town)
(State)
(Zip Code)
NAME OF LIEN-HOLDER
DATE OF LIEN
SECURITY INTEREST -
4
Loan or Lien Information
ADDRESS OF LIEN-HOLDER (Number and Street)
(City or Town)
(State)
(Zip Code)
NAME AND ADDRESS OF SECOND LIEN-HOLDER (Number and Street)
(City or Town)
(State)
(Zip Code)
DATE OF SECOND LIEN
TAX
IF TAX EXEMPTION IS CLAIMED READ THE REVERSE SIDE OF THIS FORM AND SPECIFY THE CODE ASSOCIATED WITH THE TAX
5
EXEMPTION
EXEMPTION AND ANY ADDITIONAL INFORMATION THAT YOU CAN PROVIDE.
CODE NO. FROM BACK OF FORM EXEMPTION INFORMATION (If leased vehicle lessor tax number if applicable)
IF CODE #3, LIST TOTAL SALES TAX PAID TO OTHER
JURISDICTION
$
The undersigned certifies that there are no liens on this vehicle except those specified above. The insurance required by Connecticut law is in effect and will be maintained during this registration
period. All property taxes due any CT Taxing Authority for any vehicle previously registered in my/our name(s) have been paid. If other than Passenger registration this vehicle is registered in
OWNER
6
accordance with Manufacturer's Maximum Gross Vehicle Weight Rating. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty
SIGNATURE(S)
of false statement, in accordance with the provisions of Section 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.
OWNER'S SIGNATURE
DATE SIGNED
CO-OWNER'S SIGNATURE
DATE SIGNED
X
X
ADDENDUM - If Additional Information is needed for your transaction, please complete the applicable sections below
NAME OF LESSEE (Person to whom or company to which vehicle is leased)
OPERATOR LIC. NO. AND STATE OF LESSEE
LEASED VEHICLE
7
INFORMATION
ADDRESS OF LESSEE (P.O. Box is Not Acceptable)
(Number and Street)
(City or Town)
(State)
(Zip Code)
NAME OF CO-LESSEE (Person to whom or company to which vehicle is leased)
OPERATOR LIC. NO. AND STATE OF CO-LESSEE
LIGHT WEIGHT (Wt. empty)
GROSS WEIGHT (Declared Weight) (Light wt. + max load)
MANUFACTURER'S GROSS VEHICLE WEIGHT RATING
OTHER THAN A PASSENGER
8
STYLE MOTOR VEHICLE
NO. AXLES
SEAT CAPACITY NO. STANDEES
CARRY SCHOOL CHILDREN?
COM. CARRIER-US DOT NO. (If assigned)
COMPLETE FOR APPLICABLE
VEHICLES (Buses, Trucks)
YES
NO
INTERSTATE COMMERCE?
HAZARDOUS MATERIAL?
USED FOR THE
TRAILERS -
Rear lights required. Brakes required if 3,000 lbs. or more GVWR.
TRANSPORTATION
YES
NO
YES
NO
YES
NO
Length of vehicle & trailer combined must be in accordance with CGS 14-262.
OF A VESSEL (BOAT)?
VEHICLE I.D. NUMBER OF TRADED-IN VEHICLE
YEAR
MAKE
MODEL
DEALER
9
TRANSACTION
CONNECTICUT SALES TAX PERMIT NO.
TOTAL SALES PRICE
TRADE-IN ALLOWANCE
NET SALES PRICE
STATE TAX COLLECTED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in accordance with provisions of Section 14-110 & 53a-157b of the Connecticut General Statutes.
CONNECTICUT DEALER LICENSE NUMBER
DEALER SIGNATURE (Authorized Representative)
DATE SIGNED
X
CONNECTICUT REGISTRATION AND
STATE OF CONNECTICUT
TITLE APPLICATION
DMV USE ONLY - TEMPORARY PLATE NUMBER
DEPARTMENT OF MOTOR VEHICLES
H-13B REV. 6-2018
60 STATE STREET, WETHERSFIELD, CT 06161
INSTRUCTIONS:
http://www.ct.gov/dmv
DMV USE ONLY - PERMANENT PLATE NUMBER
(1)
Please print using a black or blue pen.
(2)
Fill out the applicable sections of this form.
(3)
Use the DMV website to check for all documents required to complete your transaction and for any outstanding compliance issues.
OWNER'S (APPLICANT'S) NAME (Last, First, Middle Initial)
OWNER'S BIRTHDATE
OWNER SECTION
1
(APPLICANT)
OWNER'S LICENSE OR ID NUMBER
STATE WHERE ISSUED SECRETARY OF STATE NO. (If Applicable)
PHONE NUMBER (Optional)
IF CO-OWNERSHIP (Check one)
CO-OWNER'S (CO-APPLICANT'S) NAME (Last, First, Middle Initial)
CO-OWNER'S BIRTHDATE
JOINT/OR -
Requires ONE
signature to transfer ownership
COMMON/AND -
Requires ALL
CO-OWNER'S LICENSE OR ID NUMBER
STATE WHERE ISSUED SECRETARY OF STATE NO. (If Applicable)
PHONE NUMBER (Optional)
signatures to transfer ownership
OWNER'S MAILING ADDRESS
(Number and Street, and Apartment No. if applicable)
(City or Town)
(State)
(Zip Code)
CT RESIDENT?
RESIDENT ADDRESS (If Different from Mailing Address - PO Box is NOT acceptable. Please include Apartment No. if applicable)
YES
NO
IF DIFFERENT FROM RESIDENT ADDRESS, INDICATE HERE
CHECK BOX IF RESIDENT ADDRESS IS WHERE
(Number and Street, Apartment No.)
(City or Town)
(State)
(Zip Code)
VEHICLE
MOST
FREQUENTLY
LEAVES
FROM,
RETURNS TO, OR REMAINS (For Property Tax)
VEHICLE I.D. NUMBER
YEAR
MAKE
MODEL NAME OR NO.
BODY STYLE (4-Dr. Sedan, etc.)
VEHICLE
2
INFORMATION
FUEL TYPE (Gas, Diesel, etc.)
CYLINDERS or CC's
NO. OF WHEELS
COLOR(S) (Maximum of Two)
ODOMETER READING (Mileage)
NEW OR USED?
If Commercial use,
Combination use or Pick-Up
NEW
USED
Truck Complete Section 8
NAME OF SELLER(S) (If 2 owners, include both names)
DATE VEHICLE SOLD (Purchased)
SELLING PRICE
SELLER'S
3
INFORMATION
SELLER'S ADDRESS (Number and Street)
(City or Town)
(State)
(Zip Code)
NAME OF LIEN-HOLDER
DATE OF LIEN
SECURITY INTEREST -
4
Loan or Lien Information
ADDRESS OF LIEN-HOLDER (Number and Street)
(City or Town)
(State)
(Zip Code)
NAME AND ADDRESS OF SECOND LIEN-HOLDER (Number and Street)
(City or Town)
(State)
(Zip Code)
DATE OF SECOND LIEN
TAX
IF TAX EXEMPTION IS CLAIMED READ THE REVERSE SIDE OF THIS FORM AND SPECIFY THE CODE ASSOCIATED WITH THE TAX
5
EXEMPTION
EXEMPTION AND ANY ADDITIONAL INFORMATION THAT YOU CAN PROVIDE.
CODE NO. FROM BACK OF FORM EXEMPTION INFORMATION (If leased vehicle lessor tax number if applicable)
IF CODE #3, LIST TOTAL SALES TAX PAID TO OTHER
JURISDICTION
$
The undersigned certifies that there are no liens on this vehicle except those specified above. The insurance required by Connecticut law is in effect and will be maintained during this registration
period. All property taxes due any CT Taxing Authority for any vehicle previously registered in my/our name(s) have been paid. If other than Passenger registration this vehicle is registered in
OWNER
6
accordance with Manufacturer's Maximum Gross Vehicle Weight Rating. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty
SIGNATURE(S)
of false statement, in accordance with the provisions of Section 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.
OWNER'S SIGNATURE
DATE SIGNED
CO-OWNER'S SIGNATURE
DATE SIGNED
X
X
ADDENDUM - If Additional Information is needed for your transaction, please complete the applicable sections below
NAME OF LESSEE (Person to whom or company to which vehicle is leased)
OPERATOR LIC. NO. AND STATE OF LESSEE
LEASED VEHICLE
7
INFORMATION
ADDRESS OF LESSEE (P.O. Box is Not Acceptable)
(Number and Street)
(City or Town)
(State)
(Zip Code)
NAME OF CO-LESSEE (Person to whom or company to which vehicle is leased)
OPERATOR LIC. NO. AND STATE OF CO-LESSEE
LIGHT WEIGHT (Wt. empty)
GROSS WEIGHT (Declared Weight) (Light wt. + max load)
MANUFACTURER'S GROSS VEHICLE WEIGHT RATING
OTHER THAN A PASSENGER
8
STYLE MOTOR VEHICLE
NO. AXLES
SEAT CAPACITY NO. STANDEES
CARRY SCHOOL CHILDREN?
COM. CARRIER-US DOT NO. (If assigned)
COMPLETE FOR APPLICABLE
VEHICLES (Buses, Trucks)
YES
NO
INTERSTATE COMMERCE?
HAZARDOUS MATERIAL?
USED FOR THE
TRAILERS -
Rear lights required. Brakes required if 3,000 lbs. or more GVWR.
TRANSPORTATION
YES
NO
YES
NO
YES
NO
Length of vehicle & trailer combined must be in accordance with CGS 14-262.
OF A VESSEL (BOAT)?
VEHICLE I.D. NUMBER OF TRADED-IN VEHICLE
YEAR
MAKE
MODEL
DEALER
9
TRANSACTION
CONNECTICUT SALES TAX PERMIT NO.
TOTAL SALES PRICE
TRADE-IN ALLOWANCE
NET SALES PRICE
STATE TAX COLLECTED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in accordance with provisions of Section 14-110 & 53a-157b of the Connecticut General Statutes.
CONNECTICUT DEALER LICENSE NUMBER
DEALER SIGNATURE (Authorized Representative)
DATE SIGNED
X
SALES TAX INSTRUCTIONS
A)
SALES OR USE TAX COMPUTATION - The sales or use tax is based on the invoiced purchase price for vehicles purchased from a licensed dealer. If
the vehicle is purchased from a private individual, not from a licensed dealer, the sales or use tax is based on the current month's issue of the N.A.D.A.
Official Used Car Guide, Eastern Edition or the Bill of Sale, whichever is greater.
SALES TAX PAID IN ANOTHER STATE - In order to obtain credit for sales/use tax paid to another jurisdiction, you must present proof of payment in
B)
the form of an official receipt or dealer's invoice.
C)
BARTER, TRADE, SWAP - When two individuals trade vehicles, each must pay sales/use tax on the value of the vehicle received based on the current
month's issue of the N.A.D.A. Official Used Car Guide, Eastern Edition.
D)
CHECKS - Please make your check payable to "DMV". The total for all DMV fees also will include the sales tax.
E)
REFUNDS - Claims for sales or use tax refunds must be submitted to the Department of Revenue Services. Use CERT-106, Claim for Refund of Use
Tax Paid on Motor Vehicle Purchased from Other Than a Motor Vehicle Dealer, to claim a refund of use tax paid on a motor vehicle purchased from
other than a motor vehicle dealer. A CERT-106 form is available at all DMV branches. All other claims for refund, with supporting documents, must be
directed to the Department of Revenue Services, Refunds, Public Services Unit, 450 Columbus Boulevard, Suite 1, Hartford, CT 06103.
SPECIAL INSTRUCTIONS FOR THOSE CLAIMING EXEMPTION FROM CONNECTICUT SALES OR USE TAX
Specify the applicable code (1, 2, 3, 4, or 5) as described below in the space on the front in SECTION 7 labeled TAX EXEMPTION. Include additional
information as required below for the applicable code in the area labeled EXEMPTION INFORMATION.
Code 1:
Transfer between immediate family members (Only MOTHER, FATHER, SPOUSE (wife, husband, civil union), DAUGHTER, SON,
SISTER or BROTHER qualify as "immediate family members"). Specify code "1" and in the area labeled EXEMPTION INFORMATION,
write which of the above-listed relationships describes the person from whom you obtained the vehicle. Specify the state in which this
immediate family member previously registered the vehicle. In order to qualify for this exemption, the vehicle must have been registered in
this immediate family member's name for at least 60 days.
Sale to a Connecticut exempt organization or to a governmental agency. Specify code "2" and write the Connecticut Tax Exemption
Code 2:
Number beginning with "E" in the area labeled EXEMPTION INFORMATION or attach a copy of the organization's Internal Revenue Code
Section 501(c)(3) or 501(c)(13) exemption letter issued by the IRS.
Code 3:
Sales or Use Tax was paid to another jurisdiction. An official receipt or dealer's invoice must be presented identifying the amount of
sales tax paid. Specify code "3" and, in the area labeled EXEMPTION INFORMATION, write the amount of tax paid and the jurisdiction to
which this tax was paid.
Code 4:
Vehicles purchased while residing outside of Connecticut. Out-of-state registration or photocopy is required. Vehicles should have
been registered out-of-state at least 30 days prior to application for Connecticut registration. Specify code "4" and, in the area labeled
EXEMPTION INFORMATION, write in order (1) the state in which you were residing when you purchased vehicle, (2) the date the vehicle
was purchased, (3) the date the vehicle was registered in that state, and (4) the date the vehicle was first moved to Connecticut.
Code 5:
Other reasons. Specify code "5" and write the applicable letter from the list below in the area labeled EXEMPTION INFORMATION.
5A)
GIFT - If vehicle was received as a gift, provide a copy of form AU-463, "Motor Vehicle and Vessel Gift Declaration". These forms
are available at all DMV offices.
5B)
VEHICLE PURCHASED BY A LESSOR EXCLUSIVELY FOR LEASE OR RENTAL - Provide the Connecticut Tax Registration
Number of the lessor/purchaser.
5C)
SALE BY A FEDERAL AGENCY, FEDERAL CREDIT UNION OR AMERICAN RED CROSS - Vehicle must have been obtained
from a Federal Agency, a Federal Credit Union or the American Red Cross.
5D)
CORPORATE ORGANIZATION, REORGANIZATION OR LIQUIDATION - Acquiring a vehicle in connection with the organization,
reorganization or liquidation of an incorporated business provided (a) the last taxable sale, transfer or use of the motor vehicle was
subjected to Connecticut sales or use tax, (b) the transferee is the incorporated business or a stockholder thereof.
5E)
PARTNERSHIP OR LLC ORGANIZATION OR TERMINATION - Acquiring a vehicle in connection with the organization or
termination of a partnership or LLC provided (a) the last taxable sale, transfer or use of the motor vehicle was subjected to
Connecticut sales or use tax, and (b) the purchaser is the partnership or limited liability company, as the case may be, or a partner
or member, thereof, as the case may be.
5F)
HIGH MPG PASSENGER MOTOR VEHICLES - Section 12-412(110) exempts the sale on and after January 1, 2008, and prior to
July 1, 2010, of any passenger motor vehicle, as defined in section 14-1, that has a U.S. EPA estimated city or highway gasoline
mileage rating of at least 40 miles per gallon.
5G)
COMMERCIAL TRUCKS, TRUCK TRACTORS, TRACTORS AND SEMITRAILERS AND VEHICLES USED IN COMBINATION
THEREWITH - Section 12-412(70)(A)(i) exempts commercial trucks, truck tractors, tractors and semitrailers and vehicles used in
combination therewith which have a gross vehicle weight rating in excess of 26,000 pounds.
Section 12-412(70)(A)(ii) exempts commercial trucks, truck tractors, tractors and semitrailers and vehicles used in combination
therewith operated actively and exclusively during the period commencing upon its purchase and ending one year after the date of
purchase for the carriage of interstate freight pursuant to a certificate or permit issued by the Interstate Commerce Commission
(ICC) or its successor agency. Purchaser - please attach a copy of your certificate or permit that was issued by the ICC or its
successor agency, and a copy of a properly completed Dept. of Revenue Services CERT-105, Commercial Motor Vehicle
Purchased Within Connecticut for Use in the Carriage of Freight in Interstate Commerce.
For further information about sales and use taxes, see the DRS website (www.ct.gov/drs) or call DRS during business hours, Monday through Friday:
1-800-382-9463 (Connecticut calls outside the Greater Hartford calling area only); or
860-297-5962 (from anywhere).
TTY, TDD, and Text Telephone users only may transmit inquiries anytime by calling 860-297-4911.

Download Form H-13B Connecticut Registration and Title Application - Connecticut

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