Form R-289 "Leasing/Renting License Compliance Certification" - Connecticut

What Is Form R-289?

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 August 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-289 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-289 "Leasing/Renting License Compliance Certification" - Connecticut

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LEASING/RENTING LICENSE COMPLIANCE CERTIFICATION
R-289 REV. 8-2001
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS DIVISION
On The Web At ct.gov/dmv
INSTRUCTIONS:
1.
Please type or print clearly.
2.
Leasing Companies with rental locations in Connecticut must complete Sections A, B, and D. Leasing Companies which do business in Connecticut
without Connecticut based rental locations must complete Sections A, C, and D.
3.
Use additional sheets as needed and submit to the address below.
TO: Department of Motor Vehicles, Dealers and Repairers division, 60 State Street, Wethersfield, CT 06161.
SECTION A - GENERAL INFORMATION
NAME OF LEASING COMPANY
LICENSE NUMBER
ADDRESS OF LEASING COMPANY
BUSINESS TELEPHONE NUMBER
NAME OF OWNER/MANAGER
ADDRESS OF OWNER/MANAGER
OWNER/MANAGER TELEPHONE NO.
SECTION B - LEASING COMPANIES WITH RENTAL LOCATIONS IN CONNECTICUT
TOTAL NUMBER OF RENTAL LOCATIONS IN CONNECTICUT
NO. OF VEHICLES AT ALL CONNECTICUT RENTAL LOCATIONS (Approximate annual volume)
HOW MANY OF THESE VEHICLES ARE REGISTERED IN CONNECTICUT?
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#1
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#2
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#3
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#4
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#5
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#6
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#7
SECTION C - LEASING COMPANIES WITH NO RENTAL LOCATIONS IN CONNECTICUT
NO. OF VEHICLES LEASED TO CT RESIDENTS OR FIRMS FOR USE IN CT (Approximate annual volume)
HOW MANY OF THESE VEHICLES ARE REGISTERED IN CONNECTICUT?
SECTION D - CERTIFICATION
I declare under penalties of false statement that the information furnished above is true and accurate to the best of my knowledge and belief.
AUTHORIZED SIGNATURE
TITLE
DATE SIGNED
X
LEASING/RENTING LICENSE COMPLIANCE CERTIFICATION
R-289 REV. 8-2001
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS DIVISION
On The Web At ct.gov/dmv
INSTRUCTIONS:
1.
Please type or print clearly.
2.
Leasing Companies with rental locations in Connecticut must complete Sections A, B, and D. Leasing Companies which do business in Connecticut
without Connecticut based rental locations must complete Sections A, C, and D.
3.
Use additional sheets as needed and submit to the address below.
TO: Department of Motor Vehicles, Dealers and Repairers division, 60 State Street, Wethersfield, CT 06161.
SECTION A - GENERAL INFORMATION
NAME OF LEASING COMPANY
LICENSE NUMBER
ADDRESS OF LEASING COMPANY
BUSINESS TELEPHONE NUMBER
NAME OF OWNER/MANAGER
ADDRESS OF OWNER/MANAGER
OWNER/MANAGER TELEPHONE NO.
SECTION B - LEASING COMPANIES WITH RENTAL LOCATIONS IN CONNECTICUT
TOTAL NUMBER OF RENTAL LOCATIONS IN CONNECTICUT
NO. OF VEHICLES AT ALL CONNECTICUT RENTAL LOCATIONS (Approximate annual volume)
HOW MANY OF THESE VEHICLES ARE REGISTERED IN CONNECTICUT?
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#1
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#2
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#3
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#4
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#5
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#6
ADDRESS AND TRADE NAME (If different from name of licensee)
BUSINESS TELEPHONE NUMBER
RENTAL
LOCATION
NAME OF MANAGER
NO. OF VEHICLES IN FLEET (Annual volume)
HOW MANY ARE REGISTERED IN CT?
#7
SECTION C - LEASING COMPANIES WITH NO RENTAL LOCATIONS IN CONNECTICUT
NO. OF VEHICLES LEASED TO CT RESIDENTS OR FIRMS FOR USE IN CT (Approximate annual volume)
HOW MANY OF THESE VEHICLES ARE REGISTERED IN CONNECTICUT?
SECTION D - CERTIFICATION
I declare under penalties of false statement that the information furnished above is true and accurate to the best of my knowledge and belief.
AUTHORIZED SIGNATURE
TITLE
DATE SIGNED
X