Form H-100 "Notice of Intent to Sell" - Connecticut

What Is Form H-100?

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 February 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-100 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-100 "Notice of Intent to Sell" - Connecticut

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NOTICE OF INTENT TO SELL
H-100 REV. 2-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
60 STATE STREET, WETHERSFIELD, CT 06161-5520
DEALERS AND REPAIRERS SECTION
On The Web At: ct.gov/dmv
INSTRUCTIONS
1.
This form is not to be used for artificers' liens (see form H-100A).
2.
Print or type the entire form clearly.
3.
Date and sign the notification at the bottom of the form and submit to the address above.
4.
Enclose a fee of $10.00. Make check or money order payable to "DMV". The $10.00. fee is required to file a NOTICE OF INTENT TO SELL.
5.
If a copy of this form is used for owner/lienholder notification, it can be sent prior to filing the form with DMV, but notice to the
owner/lienholder must be sent via CERTIFIED MAIL, RETURN RECEIPT REQUESTED.
INTENT TO SELL - $10.00 Fee Required
Complete this form if the motor vehicle was towed by a licensed wrecker at the request of the police or at the request of the
property owner. Enclose fee of $10.00. I HAVE NOTIFIED THE OWNER AND ALL LIENHOLDERS (IF ANY) VIA CERTIFIED MAIL,
RETURN RECEIPT REQUESTED.
NAME OF DEALER/REPAIRER AND PHONE NUMBER
DATE VEHICLE PLACED IN CUSTODY OF
DEALER/REPAIRER
DEALER/
REPAIRER
ADDRESS OF DEALER/REPAIRER
DEALER/REPAIRER LICENSE NUMBER
INFORMATION
NAME OF LIENHOLDER(S)
LIENHOLDER
INFORMATION
ADDRESS OF LIENHOLDER(S)
PERIOD VEHICLE IN CUSTODY OF DEALER OR REPAIRER (Check one and fill in value of the vehicle)
APPROXIMATE VALUE OF VEHICLE
IN EXCESS OF 15 DAYS
$
APPROXIMATE VALUE OF VEHICLE
IN EXCESS OF 45 DAYS
$
YEAR
MAKE
MODEL
ODOMETER READING
VEHICLE
INFORMATION
VEHICLE IDENTIFICATION NUMBER (or chassis number)
COLOR
NUMBER OF CYLINDERS
BODY STYLE
FUEL TYPE
MARKER PLATE NUMBER (If plate is on vehicle)
STATE
BY WHOM WAS VEHICLE PLACED IN CUSTODY OF BUSINESS? (If police tow, fill in officer's name and department)
OWNER WAS PRESENT AT TIME OF TOW?
YES
NO
NAME OF OWNER(S)
OWNER
INFORMATION
ADDRESS OF OWNER(S)
NOTICE TO VEHICLE OWNER/LIENHOLDER: Any sale proceeds in excess of the Dealer or Repairer's charges and obligations may be claimed by the
vehicle owner within one year from the date of the sale.
DATE OF SALE
TIME OF SALE
PLACE OF SALE
MANNER OF SALE (e.g. Auction)
OWNER(S):
CERTIFIED MAIL TRACKING NUMBERS FOR
OWNER/LIENHOLDER NOTIFICATION:
LIENHOLDER(S) (IF ANY):
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with 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.
AUTHORIZED SIGNATURE
DATE SIGNED
X
NOTICE OF INTENT TO SELL
H-100 REV. 2-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
60 STATE STREET, WETHERSFIELD, CT 06161-5520
DEALERS AND REPAIRERS SECTION
On The Web At: ct.gov/dmv
INSTRUCTIONS
1.
This form is not to be used for artificers' liens (see form H-100A).
2.
Print or type the entire form clearly.
3.
Date and sign the notification at the bottom of the form and submit to the address above.
4.
Enclose a fee of $10.00. Make check or money order payable to "DMV". The $10.00. fee is required to file a NOTICE OF INTENT TO SELL.
5.
If a copy of this form is used for owner/lienholder notification, it can be sent prior to filing the form with DMV, but notice to the
owner/lienholder must be sent via CERTIFIED MAIL, RETURN RECEIPT REQUESTED.
INTENT TO SELL - $10.00 Fee Required
Complete this form if the motor vehicle was towed by a licensed wrecker at the request of the police or at the request of the
property owner. Enclose fee of $10.00. I HAVE NOTIFIED THE OWNER AND ALL LIENHOLDERS (IF ANY) VIA CERTIFIED MAIL,
RETURN RECEIPT REQUESTED.
NAME OF DEALER/REPAIRER AND PHONE NUMBER
DATE VEHICLE PLACED IN CUSTODY OF
DEALER/REPAIRER
DEALER/
REPAIRER
ADDRESS OF DEALER/REPAIRER
DEALER/REPAIRER LICENSE NUMBER
INFORMATION
NAME OF LIENHOLDER(S)
LIENHOLDER
INFORMATION
ADDRESS OF LIENHOLDER(S)
PERIOD VEHICLE IN CUSTODY OF DEALER OR REPAIRER (Check one and fill in value of the vehicle)
APPROXIMATE VALUE OF VEHICLE
IN EXCESS OF 15 DAYS
$
APPROXIMATE VALUE OF VEHICLE
IN EXCESS OF 45 DAYS
$
YEAR
MAKE
MODEL
ODOMETER READING
VEHICLE
INFORMATION
VEHICLE IDENTIFICATION NUMBER (or chassis number)
COLOR
NUMBER OF CYLINDERS
BODY STYLE
FUEL TYPE
MARKER PLATE NUMBER (If plate is on vehicle)
STATE
BY WHOM WAS VEHICLE PLACED IN CUSTODY OF BUSINESS? (If police tow, fill in officer's name and department)
OWNER WAS PRESENT AT TIME OF TOW?
YES
NO
NAME OF OWNER(S)
OWNER
INFORMATION
ADDRESS OF OWNER(S)
NOTICE TO VEHICLE OWNER/LIENHOLDER: Any sale proceeds in excess of the Dealer or Repairer's charges and obligations may be claimed by the
vehicle owner within one year from the date of the sale.
DATE OF SALE
TIME OF SALE
PLACE OF SALE
MANNER OF SALE (e.g. Auction)
OWNER(S):
CERTIFIED MAIL TRACKING NUMBERS FOR
OWNER/LIENHOLDER NOTIFICATION:
LIENHOLDER(S) (IF ANY):
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with 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.
AUTHORIZED SIGNATURE
DATE SIGNED
X