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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

B-58 REV. 12-2013

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' license/non-driver ID numbers are listed.

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 license/non-driver ID(s) and registration(s). On the registration(s), cross out the old address and write the new address in the space provided. Affix the new address label to the BACK of your license/non-driver ID(s). Labels can be obtained from any Police Department or by calling DMV's Phone Center.

5.In addition to DMV, PLEASE contact your local post office to change your official mailing address.

CHECK CHANGES

OPERATOR'S LICENSE/NON-DRIVER ID

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 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.

OPERATOR'S LICENSE/NON-DRIVER ID NUMBER(S) (9 digits)

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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