Form H-109 "Municipality Report of Abandoned Motor Vehicle" - Connecticut

What Is Form H-109?

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-109 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-109 "Municipality Report of Abandoned Motor Vehicle" - Connecticut

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MUNICIPALITY REPORT OF ABANDONED MOTOR VEHICLE
STATE OF CONNECTICUT
- -
DEPARTMENT OF MOTOR VEHICLES
H-109 REV. 3-2018
TITLE SECTION
60 STATE STREET, WETHERSFIELD, CT 06161
INSTRUCTIONS
On The Web At ct.gov/dmv
1.
Complete SECTION A for each abandoned motor vehicle which is determined to be: (a) valued at $500.00 or less; (b) unusable as a motor vehicle; and (c)
without a valid marker plate (C.G.S. §14-150(d)).
2.
Submit original form to the Department of Motor Vehicles within 48 HOURS of the time the motor vehicle is taken into custody.
Retain a copy and complete SECTION B when vehicle ownership is transferred. Submit copy to transferee in lieu of a vehicle title.
3.
TO: DEPARTMENT OF MOTOR VEHICLES, TITLE SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161
SECTION A - TO BE COMPLETED WHEN MUNICIPALITY TAKES POSSESSION OF MOTOR VEHICLES
NAME OF MUNICIPALITY (in which title is vested)
DATE AND TIME VEHICLE TAKEN INTO CUSTODY
NAME OF OFFICER OR INSPECTOR (who determines vehicle meets C.G.S. §14-150(d))
BADGE NUMBER
YEAR
MAKE/MODEL
VEHICLE IDENTIFICATION NUMBER
VEHICLE
INFORMATION
LOCATION VEHICLE ABANDONED
(No. & Street)
(City or Town)
BUSINESS NAME & ADDRESS OF TOWER
AMOUNT OF CHARGE IMPOSED BY TOWER
$
I hereby certify the above abandoned vehicle meets the specifications of C.G.S. §14-150(d) and that the vehicle identification
number has been checked through NCIC.
DEPARTMENT NAME
AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL
DATE SIGNED
X
SECTION B - TO BE COMPLETED WHEN MUNICIPALITY TRANSFERS OWNERSHIP OF MOTOR VEHICLE TO JUNKYARD
NAME
TRANSFEREE
INFORMATION
ADDRESS
(No. & Street)
(City or Town)
(State)
(Zip Code)
DEPARTMENT NAME
AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL
DATE SIGNED
X
MUNICIPALITY REPORT OF ABANDONED MOTOR VEHICLE
STATE OF CONNECTICUT
- -
DEPARTMENT OF MOTOR VEHICLES
H-109 REV. 3-2018
TITLE SECTION
60 STATE STREET, WETHERSFIELD, CT 06161
INSTRUCTIONS
On The Web At ct.gov/dmv
1.
Complete SECTION A for each abandoned motor vehicle which is determined to be: (a) valued at $500.00 or less; (b) unusable as a motor vehicle; and (c)
without a valid marker plate (C.G.S. §14-150(d)).
2.
Submit original form to the Department of Motor Vehicles within 48 HOURS of the time the motor vehicle is taken into custody.
Retain a copy and complete SECTION B when vehicle ownership is transferred. Submit copy to transferee in lieu of a vehicle title.
3.
TO: DEPARTMENT OF MOTOR VEHICLES, TITLE SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161
SECTION A - TO BE COMPLETED WHEN MUNICIPALITY TAKES POSSESSION OF MOTOR VEHICLES
NAME OF MUNICIPALITY (in which title is vested)
DATE AND TIME VEHICLE TAKEN INTO CUSTODY
NAME OF OFFICER OR INSPECTOR (who determines vehicle meets C.G.S. §14-150(d))
BADGE NUMBER
YEAR
MAKE/MODEL
VEHICLE IDENTIFICATION NUMBER
VEHICLE
INFORMATION
LOCATION VEHICLE ABANDONED
(No. & Street)
(City or Town)
BUSINESS NAME & ADDRESS OF TOWER
AMOUNT OF CHARGE IMPOSED BY TOWER
$
I hereby certify the above abandoned vehicle meets the specifications of C.G.S. §14-150(d) and that the vehicle identification
number has been checked through NCIC.
DEPARTMENT NAME
AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL
DATE SIGNED
X
SECTION B - TO BE COMPLETED WHEN MUNICIPALITY TRANSFERS OWNERSHIP OF MOTOR VEHICLE TO JUNKYARD
NAME
TRANSFEREE
INFORMATION
ADDRESS
(No. & Street)
(City or Town)
(State)
(Zip Code)
DEPARTMENT NAME
AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL
DATE SIGNED
X