Form R-95 "Application for Inspection of Composite Motor Vehicle" - Connecticut

What Is Form R-95?

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, 2001;
  • 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-95 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-95 "Application for Inspection of Composite Motor Vehicle" - Connecticut

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APPLICATION FOR INSPECTION OF
STATE OF CONNECTICUT
COMPOSITE MOTOR VEHICLE
DEPARTMENT OF MOTOR VEHICLES
R-95 REV. 6-2001
BRANCH OPERATIONS DIVISION
On The Web At http:// dmvct.org
PERSONAL INFORMATION
NAME
TELEPHONE NUMBER
DATE OF REQUEST
ADDRESS
(Street and Number)
(City or Town)
(State)
(Zip Code)
VEHICLE INFORMATION
ENGINE YEAR
ENGINE MAKE
ENGINE TYPE
ENGINE ID NUMBER
BODY MATERIAL
BODY STYLE
VEHICLE COLOR
FRAME MFG. BY
YEAR FRAME MFG.
FRAME ID NUMBER
TRANSMISSION YEAR (or Transaxle)
TRANSMISSION MAKE (or Transaxle)
TRANSMISSION ID NUMBER
REAR AXLE YEAR
REAR AXLE MAKE
REAR AXLE ID NUMBER
HORN (Electric or Other)
WINDSHIELD MARKINGS
NUMBER OF WINDSHIELD WIPERS
NUMBER OF MIRRORS
TYPE OF SERVICE BRAKES
PARKING BRAKE TYPE
TYPE OF SEAT BELTS USED
HYDRAULIC
OTHER
FRONT WHEEL AND TIRE SIZE
REAR WHEEL AND TIRE SIZE
IS THE ELECTRICAL WIRING COLOR CODED?
IS FUEL TANK VENTED?
IS THIS VEHICLE COMPOSED OF NEW OR USED PARTS?
HEIGHT OF VEHICLE
WIDTH OF VEHICLE
LENGTH OF VEHICLE
GIVE A BRIEF DESCRIPTION OF HOW THIS VEHICLE WAS ASSEMBLED (i.e. kits , from several vehicles, etc.)
LIST SOURCE OF DRIVETRAIN, FRAME, BODY, AND FENDER COMPONENTS
*A PHOTOGRAPH OF THIS VEHICLE MUST BE SUBMITTED WITH THIS REPORT*
DMV USE ONLY
ASSIGNED YEAR
TYPE
GLIDER-KIT
STREET ROD
KIT CAR
MOTORCYCLE
OTHER
COMPOSITE
ASSIGNED VIN
OTHER
TOTAL
FEES
COLLECTED
DATE
CT ASSIGNED VIN
INSPECTION TICKET NUMBER
PASSED
OUT-OF-STATE ASSIGNED VIN
REJECTED
SIGNATURE OF EXAMINING INSPECTOR
BADGE NUMBER
DATE
X
APPLICATION FOR INSPECTION OF
STATE OF CONNECTICUT
COMPOSITE MOTOR VEHICLE
DEPARTMENT OF MOTOR VEHICLES
R-95 REV. 6-2001
BRANCH OPERATIONS DIVISION
On The Web At http:// dmvct.org
PERSONAL INFORMATION
NAME
TELEPHONE NUMBER
DATE OF REQUEST
ADDRESS
(Street and Number)
(City or Town)
(State)
(Zip Code)
VEHICLE INFORMATION
ENGINE YEAR
ENGINE MAKE
ENGINE TYPE
ENGINE ID NUMBER
BODY MATERIAL
BODY STYLE
VEHICLE COLOR
FRAME MFG. BY
YEAR FRAME MFG.
FRAME ID NUMBER
TRANSMISSION YEAR (or Transaxle)
TRANSMISSION MAKE (or Transaxle)
TRANSMISSION ID NUMBER
REAR AXLE YEAR
REAR AXLE MAKE
REAR AXLE ID NUMBER
HORN (Electric or Other)
WINDSHIELD MARKINGS
NUMBER OF WINDSHIELD WIPERS
NUMBER OF MIRRORS
TYPE OF SERVICE BRAKES
PARKING BRAKE TYPE
TYPE OF SEAT BELTS USED
HYDRAULIC
OTHER
FRONT WHEEL AND TIRE SIZE
REAR WHEEL AND TIRE SIZE
IS THE ELECTRICAL WIRING COLOR CODED?
IS FUEL TANK VENTED?
IS THIS VEHICLE COMPOSED OF NEW OR USED PARTS?
HEIGHT OF VEHICLE
WIDTH OF VEHICLE
LENGTH OF VEHICLE
GIVE A BRIEF DESCRIPTION OF HOW THIS VEHICLE WAS ASSEMBLED (i.e. kits , from several vehicles, etc.)
LIST SOURCE OF DRIVETRAIN, FRAME, BODY, AND FENDER COMPONENTS
*A PHOTOGRAPH OF THIS VEHICLE MUST BE SUBMITTED WITH THIS REPORT*
DMV USE ONLY
ASSIGNED YEAR
TYPE
GLIDER-KIT
STREET ROD
KIT CAR
MOTORCYCLE
OTHER
COMPOSITE
ASSIGNED VIN
OTHER
TOTAL
FEES
COLLECTED
DATE
CT ASSIGNED VIN
INSPECTION TICKET NUMBER
PASSED
OUT-OF-STATE ASSIGNED VIN
REJECTED
SIGNATURE OF EXAMINING INSPECTOR
BADGE NUMBER
DATE
X