Form H-124 "Self-service Storage Facility Notice of Intent to Transfer" - Connecticut

What Is Form H-124?

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-124 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-124 "Self-service Storage Facility Notice of Intent to Transfer" - Connecticut

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STATE OF CONNECTICUT
SELF-SERVICE STORAGE FACILITY
DEPARTMENT OF MOTOR VEHICLES
NOTICE OF INTENT TO TRANSFER
60 STATE STREET, WETHERSFIELD, CT 06161
H-124 REV. 3-2018
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS
Cannot be submitted until sixty days after default by occupant.
1.
2.
Complete all sections.
Attach the following:
3.
Copies of the mailings to owner (if not occupant) and lienholder and return receipts.
Copy of the certified notice of default to the occupant (as specified in §42-162 C.G.S.) and return receipts.
Copy of the tenant’s occupancy agreement.
4.
Mail original form to the address above with a check or money order made payable to DMV for $10.00.
5.
Upon receipt, DMV will notify you if vehicle is approved or rejected for sale via regular mail or email.
VEHICLE IDENTIFICATION NUMBER
YEAR
MAKE/MODEL
MARKER PLATE # (IF ANY)
VEHICLE
INFORMATION
NAME OF VEHICLE OWNER
ADDRESS OF VEHICLE OWNER
NAME OF OCCUPANT WHO DEFAULTED (If different from
vehicle owner)
NAME OF LIENHOLDER(S)
VEHICLE
LIEN HOLDER
ADDRESS OF LIENHOLDER(S)
INFORMATION
NAME OF BUSINESS
NAME OF OWNER/PRINCIPAL OF BUSINESS
ADDRESS OF BUSINESS (No. and Street)
(City or Town)
(State)
(Zip Code)
SALES AND USE TAX PERMIT NUMBER
BUSINESS
INFORMATION
AMOUNT FOR WHICH A LIEN IS CLAIMED BY FACILITY
DATE VEHICLE WAS LEFT WITH FACILITY OWNER
DATE OF DEFAULT BY OCCUPANT
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 Commissioner, I will be subject to
prosecution under the above-cited laws.
CERTIFICATION
AUTHORIZED SIGNATURE OF BUSINESS OWNER/PRINCIPAL
DATE SIGNED
X
STATE OF CONNECTICUT
SELF-SERVICE STORAGE FACILITY
DEPARTMENT OF MOTOR VEHICLES
NOTICE OF INTENT TO TRANSFER
60 STATE STREET, WETHERSFIELD, CT 06161
H-124 REV. 3-2018
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS
Cannot be submitted until sixty days after default by occupant.
1.
2.
Complete all sections.
Attach the following:
3.
Copies of the mailings to owner (if not occupant) and lienholder and return receipts.
Copy of the certified notice of default to the occupant (as specified in §42-162 C.G.S.) and return receipts.
Copy of the tenant’s occupancy agreement.
4.
Mail original form to the address above with a check or money order made payable to DMV for $10.00.
5.
Upon receipt, DMV will notify you if vehicle is approved or rejected for sale via regular mail or email.
VEHICLE IDENTIFICATION NUMBER
YEAR
MAKE/MODEL
MARKER PLATE # (IF ANY)
VEHICLE
INFORMATION
NAME OF VEHICLE OWNER
ADDRESS OF VEHICLE OWNER
NAME OF OCCUPANT WHO DEFAULTED (If different from
vehicle owner)
NAME OF LIENHOLDER(S)
VEHICLE
LIEN HOLDER
ADDRESS OF LIENHOLDER(S)
INFORMATION
NAME OF BUSINESS
NAME OF OWNER/PRINCIPAL OF BUSINESS
ADDRESS OF BUSINESS (No. and Street)
(City or Town)
(State)
(Zip Code)
SALES AND USE TAX PERMIT NUMBER
BUSINESS
INFORMATION
AMOUNT FOR WHICH A LIEN IS CLAIMED BY FACILITY
DATE VEHICLE WAS LEFT WITH FACILITY OWNER
DATE OF DEFAULT BY OCCUPANT
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 Commissioner, I will be subject to
prosecution under the above-cited laws.
CERTIFICATION
AUTHORIZED SIGNATURE OF BUSINESS OWNER/PRINCIPAL
DATE SIGNED
X