Official Connecticut B 58 Template in PDF
Structure
The Connecticut B 58 form serves multiple purposes related to updating personal information with the Department of Motor Vehicles (DMV). Primarily, it is used for changing an individual's address, whether for an operator's license, non-driver ID, or vehicle registration. The form also addresses the status of organ and tissue donation, allowing individuals to express their consent or withdrawal from the donor registry. To complete the B 58 form, applicants must provide their names, current and new addresses, and relevant identification numbers. It’s important to note that joint owners can utilize the form if both parties' identification numbers are included. Additionally, the form requires signatures from all applicants, ensuring that the information is verified and accurate. After filling out the form, applicants must also inform their local post office of their address change. The B 58 form does not serve as a means for voter registration updates, which is a separate process. Proper completion and submission of this form help maintain accurate records with the DMV and ensure that individuals' preferences regarding organ donation are respected.
Connecticut B 58 Example
CHANGE OF ADDRESS AND ORGAN/TISSUE DONOR STATUS |
STATE OF CONNECTICUT |
DEPARTMENT OF MOTOR VEHICLES |
|
|
On The Web At ct.gov/dmv |
INSTRUCTIONS - PLEASE PRINT INFORMATION
1.Joint owners may use this form if both operators'
2.Form must be signed and dated by all applicants.
3.Copy information from your current registration. If more than four (4) marker plate numbers, use additional change of address forms.
4.Keep your
5.In addition to DMV, PLEASE contact your local post office to change your official mailing address.
CHECK CHANGES
OPERATOR'S
MOTOR VEHICLE REGISTRATION
VESSEL REGISTRATION
I CONSENT TO ORGAN AND TISSUE DONATION AND WISH TO BE IN THE DONOR REGISTRY
I NO LONGER WISH TO BE IN THE DONOR REGISTRY
CHANGE OF ADDRESS IS NOT FOR VOTER REGISTRATION PURPOSES
NAME (Last, First, Middle Initial) - APPLICANT 1
NAME (Last, First, Middle Initial) - APPLICANT 2
(NEW) MAILING ADDRESS (No. and Street, City or Town, State, Zip Code)
RESIDENT ADDRESS, IF DIFFERENT FROM MAILING ADDRESS
TAX TOWN - Connecticut town where vehicle in the normal course of operation most frequently leaves from, returns to or remains.
SIGNATURE |
DATE |
X
SIGNATURE |
DATE |
X
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 Section
OPERATOR'S
1.
STATE
2.
VESSEL INFORMATION
NUMBER |
EXPIRATION DATE |
|
|
REGISTRATION INFORMATION
TYPE OF PLATE (Camper, Passenger, Comb., etc) |
MARKER PLATE NUMBER |
EXPIRATION DATE |
Month Year
Month Year
Month Year
Month Year
FORMER ADDRESS
Mail this form to: DMV Data Entry, 60 State Street, Wethersfield CT 06161
Document Specifications
| Fact Name | Details |
|---|---|
| Purpose | The Connecticut B-58 form is used for changing an address and updating organ/tissue donor status. |
| Eligibility | Joint owners can use this form if both operators' license or non-driver ID numbers are provided. |
| Signature Requirement | All applicants must sign and date the form for it to be valid. |
| Address Update Process | Individuals must copy their current registration information and update their address on both their license and registration documents. |
| Mailing Address Notification | In addition to notifying the DMV, individuals should also contact their local post office to update their official mailing address. |
| Governing Laws | The form is governed by Section 14-110 and Section 53a-157b of the Connecticut General Statutes. |
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