Form R-361 "Licensed Dealer/Repairer Inspector's Report for a Public Service Vehicle" - Connecticut

What Is Form R-361?

This is a legal form that was released by the Connecticut Department of Motor Vehicles - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2007;
  • The latest edition provided by the Connecticut Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form R-361 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Motor Vehicles.

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Download Form R-361 "Licensed Dealer/Repairer Inspector's Report for a Public Service Vehicle" - Connecticut

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PUBLIC SERVICE VEHICLE
STATE OF CONNECTICUT
LICENSED DEALER/REPAIRER INSPECTOR REPORT
DEPARTMENT OF MOTOR VEHICLES
R-361 REV. 6-2007
COMMERCIAL VEHICLE SAFETY DIVISION
Instructions for Owner/Carrier: This report is to be used by a Connecticut licensed dealer/repairer. When inspecting any service bus or taxicab motor
vehicle for registration purposes (Renewals Only).
1. The owner/carrier of the vehicle must complete Section A in its ENTIRETY.
2. The owner/carrier must submit a photocopy of this PASSED report along with the renewal form.
Instructions for Connecticut Licensed Dealer/Repairer: The Connecticut licensed dealer/repairer must complete Section B, C, and the certification in
Section D in its ENTIRETY. By completing Section (D), the licensed dealer/repairer is certifying that the vehicle meets inspection standards as outlined by
the Department of Motor Vehicles. If repairs are not completed by the inspecting facility, the dealer or repairer must allow for one free inspection. All of the
defects on the report must be repaired before the vehicle can be passed.
NOTE:
Pursuant
the repair documentation on file at licensed location for a period of two (2) years after the inspection/repair of the vehicle.
OWNER/CARRIER INFORMATION (SECTION A) - MUST BE COMPLETED BY VEHICLE OWNER
OWNER/CARRIER NAME (Not Lessee)
PHONE NUMBER
ADDRESS
TOWN/CITY
STATE
ZIP CODE
MARKER PLATE NUMBER
YEAR
MAKE
MODEL
BODY STYLE
VEHICLE TYPE
TAXI
SERVICE BUS
VIN
MANUFACTURER'S
GVWR
SEATING CAPACITY
DEALER/REPAIRER LICENSE INFORMATION (SECTION B) - MUST BE COMPLETED
NAME OF REPAIRER/GARAGE
PHONE NUMBER
ADDRESS
TOWN/CITY
STATE
ZIP CODE
PRINCIPAL
DEALER/REPAIRER LICENSE NUMBER
DEALER/REPAIRER INSPECTION SECTION (SECTION C)
If the repairs are not completed by the inspecting facility, the dealer/repairer must allow for one free reinspection. All of the defects noted on the report must be repaired before the vehicle can be passed.
Pursuant to the Regulations of Connecticut State Agencies Section 14-63-40, each dealer/repairer must maintain a copy of the inspection report and the repair documentation on file at its licensed location for a
period of two (2) years after the repair of the vehicle. Customer must submit a photocopy of this report along with the renewal form.
INITIAL INSPECTION RESULTS
AUTHORIZED SIGNATURE OF DEALER/REPAIRER
DATE OF INSPECTION
INDICATE ACTUAL
INITIAL
X
MILEAGE BELOW
INSPECTION
PASS
FAIL
(ODOMETER READING)
REINSPECTION RESULTS
AUTHORIZED SIGNATURE OF DEALER/REPAIRER
DATE OF REINSPECTION
RE-
X
INSPECTION
PASS
FAIL
INSPECTION
REINSPECTION
COMMENTS (Describe Violation)
INSPECTION ITEM
PASS
FAIL
PASS
FAIL
SERVICE BRAKES
PARKING BRAKE
TIRES/WHEELS
STEERING SYSTEM
SUSPENSION
FRAME/CHASSIS
EXHAUST
FUEL SYSTEM
HEADLIGHTS
STOP/TURN LIGHTS
MISC. LIGHTS
WIPERS/WASHER
WINDSHIELD GLAZE
HORN
EMERGENCY
EQUIPMENT
MIRRORS
SEATS/SEAT BELTS
HEATER/
DEFROSTER
OTHER
DEALER/REPAIRER INSPECTION CERTIFICATION (SECTION D) - MUST BE COMPLETED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty 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.
Authorized Signature of Dealer/Repairer
Date
X
A COPY OF THIS DOCUMENT MUST BE MAINTAINED IN THE VEHICLE WITH THE REGISTRATION
PUBLIC SERVICE VEHICLE
STATE OF CONNECTICUT
LICENSED DEALER/REPAIRER INSPECTOR REPORT
DEPARTMENT OF MOTOR VEHICLES
R-361 REV. 6-2007
COMMERCIAL VEHICLE SAFETY DIVISION
Instructions for Owner/Carrier: This report is to be used by a Connecticut licensed dealer/repairer. When inspecting any service bus or taxicab motor
vehicle for registration purposes (Renewals Only).
1. The owner/carrier of the vehicle must complete Section A in its ENTIRETY.
2. The owner/carrier must submit a photocopy of this PASSED report along with the renewal form.
Instructions for Connecticut Licensed Dealer/Repairer: The Connecticut licensed dealer/repairer must complete Section B, C, and the certification in
Section D in its ENTIRETY. By completing Section (D), the licensed dealer/repairer is certifying that the vehicle meets inspection standards as outlined by
the Department of Motor Vehicles. If repairs are not completed by the inspecting facility, the dealer or repairer must allow for one free inspection. All of the
defects on the report must be repaired before the vehicle can be passed.
NOTE:
Pursuant
the repair documentation on file at licensed location for a period of two (2) years after the inspection/repair of the vehicle.
OWNER/CARRIER INFORMATION (SECTION A) - MUST BE COMPLETED BY VEHICLE OWNER
OWNER/CARRIER NAME (Not Lessee)
PHONE NUMBER
ADDRESS
TOWN/CITY
STATE
ZIP CODE
MARKER PLATE NUMBER
YEAR
MAKE
MODEL
BODY STYLE
VEHICLE TYPE
TAXI
SERVICE BUS
VIN
MANUFACTURER'S
GVWR
SEATING CAPACITY
DEALER/REPAIRER LICENSE INFORMATION (SECTION B) - MUST BE COMPLETED
NAME OF REPAIRER/GARAGE
PHONE NUMBER
ADDRESS
TOWN/CITY
STATE
ZIP CODE
PRINCIPAL
DEALER/REPAIRER LICENSE NUMBER
DEALER/REPAIRER INSPECTION SECTION (SECTION C)
If the repairs are not completed by the inspecting facility, the dealer/repairer must allow for one free reinspection. All of the defects noted on the report must be repaired before the vehicle can be passed.
Pursuant to the Regulations of Connecticut State Agencies Section 14-63-40, each dealer/repairer must maintain a copy of the inspection report and the repair documentation on file at its licensed location for a
period of two (2) years after the repair of the vehicle. Customer must submit a photocopy of this report along with the renewal form.
INITIAL INSPECTION RESULTS
AUTHORIZED SIGNATURE OF DEALER/REPAIRER
DATE OF INSPECTION
INDICATE ACTUAL
INITIAL
X
MILEAGE BELOW
INSPECTION
PASS
FAIL
(ODOMETER READING)
REINSPECTION RESULTS
AUTHORIZED SIGNATURE OF DEALER/REPAIRER
DATE OF REINSPECTION
RE-
X
INSPECTION
PASS
FAIL
INSPECTION
REINSPECTION
COMMENTS (Describe Violation)
INSPECTION ITEM
PASS
FAIL
PASS
FAIL
SERVICE BRAKES
PARKING BRAKE
TIRES/WHEELS
STEERING SYSTEM
SUSPENSION
FRAME/CHASSIS
EXHAUST
FUEL SYSTEM
HEADLIGHTS
STOP/TURN LIGHTS
MISC. LIGHTS
WIPERS/WASHER
WINDSHIELD GLAZE
HORN
EMERGENCY
EQUIPMENT
MIRRORS
SEATS/SEAT BELTS
HEATER/
DEFROSTER
OTHER
DEALER/REPAIRER INSPECTION CERTIFICATION (SECTION D) - MUST BE COMPLETED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty 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.
Authorized Signature of Dealer/Repairer
Date
X
A COPY OF THIS DOCUMENT MUST BE MAINTAINED IN THE VEHICLE WITH THE REGISTRATION