Form H-128 "Affidavit of Recreational Vehicle Transfer by Campground" - Connecticut

What Is Form H-128?

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 February 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 printable version of Form H-128 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-128 "Affidavit of Recreational Vehicle Transfer by Campground" - Connecticut

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STATE OF CONNECTICUT
AFFIDAVIT OF RECREATIONAL VEHICLE
DEPARTMENT OF MOTOR VEHICLES
TRANSFER BY CAMPGROUND
60 STATE STREET, WETHERSFIELD, CT 06161
H-128 REV. 2-2018
DEALERS AND REPAIRERS SECTION
On The Web at ct.gov/dmv
The Undersigned, being duly sworn, deposes and says:
1. I am the owner and/or operator of
(Name of Campground), a campground that is required to comply with
sections 14-150-10 through 14-150-15 of the Regulations of Connecticut State Agencies. I am authorized to act on behalf of the named campground.
2. On
(date), I filed a notice of intent to transfer the recreational vehicle described herein that was left at the campground by
(camper(s) name(s)), who abandoned the recreational vehicle for a period of at least sixty (60) days.
YEAR
VEHICLE IDENTIFICATION NUMBER
MAKE
MODEL
RECREATIONAL VEHICLE OWNER(S) (NAME AND ADDRESS)
LIENHOLDER(S) ON DMV RECORDS (NAME AND ADDRESS)
CAMPER(S) (NAME AND ADDRESS)
SECURED PARTY OR PARTIES (NAME AND ADDRESS)
3. I sent a notice that complies with section 14-150-13 of the Regulations of Connecticut State Agencies, by certified mail, return receipt requested, to the
recreational vehicle owner(s), the camper(s) (if other than the recreational vehicle owner(s)), all lienholders and all secured parties named herein.
4. The recreational vehicle described herein was sold at a public sale on
(date) at
(location) and was sold
to
(purchaser(s)). The sale was advertised on
and
(dates) in
(newspaper(s)) commencing at least ten (10) days before the sale. (Proof must be
attached.)
5. The recreational vehicle owner(s), camper(s) (if not the recreational vehicle owner(s)), all lienholders and all secured parties named herein were notified of
the date, time and place of the sale by certified mail, return receipt requested. (Proof must be attached.)
6. I have allocated the proceeds from the sale or other disposition of the recreational vehicle in accordance with subsection (a) of section 14-150-15 of the
Regulations of Connecticut State Agencies.
7. I have satisfied the lien(s) in the records of the Department of Motor Vehicles and the amount(s) claimed by secured parties recorded with the Secretary
of State, and submit the following documentation/information relative to the satisfaction of the lien(s)/claim(s):
8. I have furnished this original affidavit to the purchaser of the recreational vehicle or the purchaser's agent, along with the following documents:
• Bill of sale;
• Copies of at least two newspaper publications and the dates of publication (commencing at least ten (10) days before sale) - See paragraph
4; and
• Copies of notification to recreational vehicle owner(s), camper(s) (if not recreational vehicle owner(s)), all lienholders and all secured parties
of date, time and place of the sale, and copies of return receipts for mailing the notification -See paragraph 5.
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with 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.
Signature:
Date:
County of
State of CONNECTICUT
Subscribed and sworn to before me this
day of
, 20
at
, Connecticut
X
Notary Public/Commissioner of the Superior Court
(If Notary, commission expiration date)
STATE OF CONNECTICUT
AFFIDAVIT OF RECREATIONAL VEHICLE
DEPARTMENT OF MOTOR VEHICLES
TRANSFER BY CAMPGROUND
60 STATE STREET, WETHERSFIELD, CT 06161
H-128 REV. 2-2018
DEALERS AND REPAIRERS SECTION
On The Web at ct.gov/dmv
The Undersigned, being duly sworn, deposes and says:
1. I am the owner and/or operator of
(Name of Campground), a campground that is required to comply with
sections 14-150-10 through 14-150-15 of the Regulations of Connecticut State Agencies. I am authorized to act on behalf of the named campground.
2. On
(date), I filed a notice of intent to transfer the recreational vehicle described herein that was left at the campground by
(camper(s) name(s)), who abandoned the recreational vehicle for a period of at least sixty (60) days.
YEAR
VEHICLE IDENTIFICATION NUMBER
MAKE
MODEL
RECREATIONAL VEHICLE OWNER(S) (NAME AND ADDRESS)
LIENHOLDER(S) ON DMV RECORDS (NAME AND ADDRESS)
CAMPER(S) (NAME AND ADDRESS)
SECURED PARTY OR PARTIES (NAME AND ADDRESS)
3. I sent a notice that complies with section 14-150-13 of the Regulations of Connecticut State Agencies, by certified mail, return receipt requested, to the
recreational vehicle owner(s), the camper(s) (if other than the recreational vehicle owner(s)), all lienholders and all secured parties named herein.
4. The recreational vehicle described herein was sold at a public sale on
(date) at
(location) and was sold
to
(purchaser(s)). The sale was advertised on
and
(dates) in
(newspaper(s)) commencing at least ten (10) days before the sale. (Proof must be
attached.)
5. The recreational vehicle owner(s), camper(s) (if not the recreational vehicle owner(s)), all lienholders and all secured parties named herein were notified of
the date, time and place of the sale by certified mail, return receipt requested. (Proof must be attached.)
6. I have allocated the proceeds from the sale or other disposition of the recreational vehicle in accordance with subsection (a) of section 14-150-15 of the
Regulations of Connecticut State Agencies.
7. I have satisfied the lien(s) in the records of the Department of Motor Vehicles and the amount(s) claimed by secured parties recorded with the Secretary
of State, and submit the following documentation/information relative to the satisfaction of the lien(s)/claim(s):
8. I have furnished this original affidavit to the purchaser of the recreational vehicle or the purchaser's agent, along with the following documents:
• Bill of sale;
• Copies of at least two newspaper publications and the dates of publication (commencing at least ten (10) days before sale) - See paragraph
4; and
• Copies of notification to recreational vehicle owner(s), camper(s) (if not recreational vehicle owner(s)), all lienholders and all secured parties
of date, time and place of the sale, and copies of return receipts for mailing the notification -See paragraph 5.
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with 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.
Signature:
Date:
County of
State of CONNECTICUT
Subscribed and sworn to before me this
day of
, 20
at
, Connecticut
X
Notary Public/Commissioner of the Superior Court
(If Notary, commission expiration date)