Form H-114 "Notice of Motor Vehicle Tow" - Connecticut

What Is Form H-114?

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-114 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-114 "Notice of Motor Vehicle Tow" - Connecticut

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STATE OF CONNECTICUT
NOTICE OF MOTOR VEHICLE TOW
DEPARTMENT OF MOTOR VEHICLES
H-114 REV. 3-2018
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS FOR POLICE DEPARTMENT TOW
INSTRUCTIONS FOR PRIVATE PROPERTY TOW
1.
Please type or print clearly.
1.
Please type or print clearly.
2.
Police Officer COMPLETE SECTIONS 1, 2, 3, 4 and 5. Police retain a copy.
2.
Tower COMPLETE SECTIONS 1, 2, 3, 4 and 6. Tower must notify the Police
3.
If vehicle is not claimed within 48 hours, Police Department must send a copy
Department of the tow in writing, or by fax or e-mail, within 2 hours of the tow.
to the vehicle owner and all lienholders (if any).
3.
If vehicle is not claimed within 48 hours, tower must send a copy to the
vehicle owner, all lienholders (if any), and retain a copy.
TYPE OF TOW
DATE VEHICLE TOWED
WRECKER MARKER PLATE NUMBER
POLICE
PRIVATE
DEPARTMENT
PROPERTY
NAME OF TOWER
DEALER/REPAIRER LICENSE NO.
TELEPHONE NUMBER OF TOWER
SECTION 1
ADDRESS OF TOWER
(Number and Street)
(City or Town)
(State)
(Zip Code)
TOWER
INFORMATION
LOCATION FROM WHERE VEHICLE WAS TOWED
(Number and Street)
(City or Town)
(State)
(Zip Code)
LOCATION TO WHERE VEHICLE WAS TOWED
(Number and Street)
(City or Town)
(State)
(Zip Code)
YEAR
MAKE
MODEL
ODOMETER READING
MARKER PLATE NUMBER
SECTION 2
VEHICLE
VEHICLE IDENTIFICATION NUMBER
INFORMATION
NAME (Last, First, Middle Initial)
SECTION 3
ADDRESS
(Number and Street)
(City or Town)
(State)
(Zip Code)
CURRENT
OWNER
MAILING ADDRESS (If different)
INFORMATION
NAME OF LIENHOLDER
NAME OF SECOND LIENHOLDER
SECTION 4
LIENHOLDER
ADDRESS OF LIENHOLDER
ADDRESS OF SECOND LIENHOLDER
INFORMATION
COMMENTS/ADDITIONAL INFORMATION (Explain the circumstances surrounding the tow - include as much information as possible)
PRINTED NAME OF OFFICER WHO PLACED VEHICLE IN CUSTODY OF TOWER
BADGE NUMBER
DEPARTMENT NAME
LOCATION WHERE VEHICLE WAS TOWED FROM (Street, City, State)
POLICE CASE NUMBER
SECTION 5
IS VEHICLE DAMAGED?
NO
YES
(If yes, please explain below)
POLICE TOW
INFORMATION
(Complete for
P.D. Tow ONLY)
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 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 OF POLICE OFFICER (Or Authorized Official)
DATE SIGNED
X
NOTE TO
The owner has a right to contest the validity of a police authorized tow of a motor vehicle IN THE MUNICIPALITY FROM
VEHICLE
WHICH THE MOTOR VEHICLE WAS TOWED by making application for a hearing within ten days of this notice.
DMV Form A-25 is available at http://www.ct.gov/dmv/lib/dmv/20/29/a-25.pdf and local police departments for this purpose.
OWNER
PRINTED NAME OF PROPERTY OWNER, LESSEE OR AGENT WHO PLACED VEHICLE IN CUSTODY OF TOWER
SECTION 6
PRIVATE
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
PROPERTY
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
Commissioner, I will be subject to prosecution under the above-cited laws.
TOW
SIGNATURE OF TOWER'S REPRESENTATIVE
DATE SIGNED
INFORMATION
X
DISTRIBUTION: White - Police
Canary - Vehicle Owner
Pink - Tower
Goldenrod - Lienholder
STATE OF CONNECTICUT
NOTICE OF MOTOR VEHICLE TOW
DEPARTMENT OF MOTOR VEHICLES
H-114 REV. 3-2018
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS FOR POLICE DEPARTMENT TOW
INSTRUCTIONS FOR PRIVATE PROPERTY TOW
1.
Please type or print clearly.
1.
Please type or print clearly.
2.
Police Officer COMPLETE SECTIONS 1, 2, 3, 4 and 5. Police retain a copy.
2.
Tower COMPLETE SECTIONS 1, 2, 3, 4 and 6. Tower must notify the Police
3.
If vehicle is not claimed within 48 hours, Police Department must send a copy
Department of the tow in writing, or by fax or e-mail, within 2 hours of the tow.
to the vehicle owner and all lienholders (if any).
3.
If vehicle is not claimed within 48 hours, tower must send a copy to the
vehicle owner, all lienholders (if any), and retain a copy.
TYPE OF TOW
DATE VEHICLE TOWED
WRECKER MARKER PLATE NUMBER
POLICE
PRIVATE
DEPARTMENT
PROPERTY
NAME OF TOWER
DEALER/REPAIRER LICENSE NO.
TELEPHONE NUMBER OF TOWER
SECTION 1
ADDRESS OF TOWER
(Number and Street)
(City or Town)
(State)
(Zip Code)
TOWER
INFORMATION
LOCATION FROM WHERE VEHICLE WAS TOWED
(Number and Street)
(City or Town)
(State)
(Zip Code)
LOCATION TO WHERE VEHICLE WAS TOWED
(Number and Street)
(City or Town)
(State)
(Zip Code)
YEAR
MAKE
MODEL
ODOMETER READING
MARKER PLATE NUMBER
SECTION 2
VEHICLE
VEHICLE IDENTIFICATION NUMBER
INFORMATION
NAME (Last, First, Middle Initial)
SECTION 3
ADDRESS
(Number and Street)
(City or Town)
(State)
(Zip Code)
CURRENT
OWNER
MAILING ADDRESS (If different)
INFORMATION
NAME OF LIENHOLDER
NAME OF SECOND LIENHOLDER
SECTION 4
LIENHOLDER
ADDRESS OF LIENHOLDER
ADDRESS OF SECOND LIENHOLDER
INFORMATION
COMMENTS/ADDITIONAL INFORMATION (Explain the circumstances surrounding the tow - include as much information as possible)
PRINTED NAME OF OFFICER WHO PLACED VEHICLE IN CUSTODY OF TOWER
BADGE NUMBER
DEPARTMENT NAME
LOCATION WHERE VEHICLE WAS TOWED FROM (Street, City, State)
POLICE CASE NUMBER
SECTION 5
IS VEHICLE DAMAGED?
NO
YES
(If yes, please explain below)
POLICE TOW
INFORMATION
(Complete for
P.D. Tow ONLY)
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 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 OF POLICE OFFICER (Or Authorized Official)
DATE SIGNED
X
NOTE TO
The owner has a right to contest the validity of a police authorized tow of a motor vehicle IN THE MUNICIPALITY FROM
VEHICLE
WHICH THE MOTOR VEHICLE WAS TOWED by making application for a hearing within ten days of this notice.
DMV Form A-25 is available at http://www.ct.gov/dmv/lib/dmv/20/29/a-25.pdf and local police departments for this purpose.
OWNER
PRINTED NAME OF PROPERTY OWNER, LESSEE OR AGENT WHO PLACED VEHICLE IN CUSTODY OF TOWER
SECTION 6
PRIVATE
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
PROPERTY
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
Commissioner, I will be subject to prosecution under the above-cited laws.
TOW
SIGNATURE OF TOWER'S REPRESENTATIVE
DATE SIGNED
INFORMATION
X
DISTRIBUTION: White - Police
Canary - Vehicle Owner
Pink - Tower
Goldenrod - Lienholder