Form H-110 "Abandoned Motor Vehicle Sale Notification" - Connecticut

What Is Form H-110?

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 March 1, 2018;
  • 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 H-110 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 H-110 "Abandoned Motor Vehicle Sale Notification" - Connecticut

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ABANDONED MOTOR VEHICLE SALE NOTIFICATION
H-110 REV. 3-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS SECTION
INSTRUCTIONS:
60 STATE STREET, WETHERSFIELD, CT 06161
On The Web at ct.gov/dmv
1.
Print clearly or type.
2.
Attach H-110 to the Affidavit of Compliance (H-76).
3.
Mail copy to former owner of record.
YEAR
MAKE/MODEL
ODOMETER READING
COLOR
VEHICLE
INFORMATION
VEHICLE IDENTIFICATION NUMBER
APPROXIMATE VALUE OF VEHICLE
$1500 OR LESS
OVER $1500
NAME
WAS NOTICE OF INTENT TO SELL SENT TO OWNER?
YES
NO
OWNER OF
RECORD
ADDRESS
NAME OF DEALER/REPAIRER
ADDRESS OF DEALER/REPAIRER
SELLER
INFORMATION
DATE VEHICLE PLACED IN CUSTODY OF DEALER/REPAIRER
DEALER/REPAIRER LICENSE NUMBER
STORAGE CHARGES (If any)
TOWING CHARGES (If any)
REPAIR CHARGES (If any)
$
$
LIEN
INFORMATION
OTHER CHARGES (If any, specify)
TOTAL OF ALL CHARGES
$
$
NAME (Owner)
ADDRESS
PURCHASER(S)
PLACE OF SALE
SALES PRICE
DATE OF SALE
$
SIGNATURE OF SELLER
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
X
Commissioner, I will be subject to prosecution under the above cited laws.
ABANDONED MOTOR VEHICLE SALE NOTIFICATION
H-110 REV. 3-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS SECTION
INSTRUCTIONS:
60 STATE STREET, WETHERSFIELD, CT 06161
On The Web at ct.gov/dmv
1.
Print clearly or type.
2.
Attach H-110 to the Affidavit of Compliance (H-76).
3.
Mail copy to former owner of record.
YEAR
MAKE/MODEL
ODOMETER READING
COLOR
VEHICLE
INFORMATION
VEHICLE IDENTIFICATION NUMBER
APPROXIMATE VALUE OF VEHICLE
$1500 OR LESS
OVER $1500
NAME
WAS NOTICE OF INTENT TO SELL SENT TO OWNER?
YES
NO
OWNER OF
RECORD
ADDRESS
NAME OF DEALER/REPAIRER
ADDRESS OF DEALER/REPAIRER
SELLER
INFORMATION
DATE VEHICLE PLACED IN CUSTODY OF DEALER/REPAIRER
DEALER/REPAIRER LICENSE NUMBER
STORAGE CHARGES (If any)
TOWING CHARGES (If any)
REPAIR CHARGES (If any)
$
$
LIEN
INFORMATION
OTHER CHARGES (If any, specify)
TOTAL OF ALL CHARGES
$
$
NAME (Owner)
ADDRESS
PURCHASER(S)
PLACE OF SALE
SALES PRICE
DATE OF SALE
$
SIGNATURE OF SELLER
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
X
Commissioner, I will be subject to prosecution under the above cited laws.