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Official Connecticut H 109 Template in PDF

The Connecticut H 109 form is a document used by municipalities to report abandoned motor vehicles within the state. This form is essential for ensuring that vehicles deemed unusable and without valid registration are properly documented and processed. By following the outlined procedures, municipalities can effectively manage abandoned vehicles and facilitate their transfer to junkyards when necessary.

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Structure

The Connecticut H 109 form serves as a crucial document for municipalities in the state when dealing with abandoned motor vehicles. This form outlines specific procedures that must be followed when a vehicle is deemed abandoned, particularly those valued at $500 or less, which are unusable and lack a valid marker plate. The form requires municipalities to complete Section A upon taking possession of such vehicles, detailing information such as the vehicle's make, model, and identification number, as well as the circumstances surrounding its abandonment. It is imperative that the original form be submitted to the Department of Motor Vehicles within 48 hours of custody. Additionally, Section B must be filled out when ownership of the abandoned vehicle is transferred to a junkyard, ensuring that the new owner receives the necessary documentation in lieu of a vehicle title. The form emphasizes the importance of compliance with Connecticut General Statutes and includes certification by a municipal official to validate the process. By adhering to these guidelines, municipalities can effectively manage abandoned vehicles while maintaining accurate records and ensuring proper transfer of ownership.

Connecticut H 109 Example

MUNICIPALITY REPORT OF ABANDONED MOTOR VEHICLE	STATE OF CONNECTICUT	-
H-109 REV. 3-2018	DEPARTMENT OF MOTOR VEHICLES	-
	TITLE SECTION
INSTRUCTIONS	60 STATE STREET, WETHERSFIELD, CT 06161
INSTRUCTIONS	On The Web At ct.gov/dmv

1.Complete SECTION A for each abandoned motor vehicle which is determined to be: (a) valued at $500.00 or less; (b) unusable as a motor vehicle; and (c) without a valid marker plate (C.G.S. §14-150(d)).

2.Submit original form to the Department of Motor Vehicles within 48 HOURS of the time the motor vehicle is taken into custody.

3.Retain a copy and complete SECTION B when vehicle ownership is transferred. Submit copy to transferee in lieu of a vehicle title.

TO: DEPARTMENT OF MOTOR VEHICLES, TITLE SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161

SECTION A - TO BE COMPLETED WHEN MUNICIPALITY TAKES POSSESSION OF MOTOR VEHICLES

NAME OF MUNICIPALITY (in which title is vested)

DATE AND TIME VEHICLE TAKEN INTO CUSTODY

NAME OF OFFICER OR INSPECTOR (who determines vehicle meets C.G.S. §14-150(d))

BADGE NUMBER

VEHICLE

INFORMATION

YEAR	MAKE/MODEL	VEHICLE IDENTIFICATION NUMBER

LOCATION VEHICLE ABANDONED	(No. & Street)	(City or Town)

BUSINESS NAME & ADDRESS OF TOWER

AMOUNT OF CHARGE IMPOSED BY TOWER

I hereby certify the above abandoned vehicle meets the specifications of C.G.S. §14-150(d) and that the vehicle identification number has been checked through NCIC.

DEPARTMENT NAME

AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL

DATE SIGNED

SECTION B - TO BE COMPLETED WHEN MUNICIPALITY TRANSFERS OWNERSHIP OF MOTOR VEHICLE TO JUNKYARD

TRANSFEREE INFORMATION

NAME

ADDRESS

(No. & Street)

(City or Town)

(State)

(Zip Code)

DEPARTMENT NAME

AUTHORIZED SIGNATURE OF MUNICIPAL OFFICIAL

DATE SIGNED

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Document Specifications

Fact Name	Details
Form Title	The official title of the form is the "Municipality Report of Abandoned Motor Vehicle." This indicates its purpose in documenting abandoned vehicles.
Governing Law	This form is governed by Connecticut General Statutes (C.G.S. §14-150(d)), which outlines the criteria for determining abandoned vehicles.
Submission Timeline	Municipalities must submit the completed form to the Department of Motor Vehicles within 48 hours of taking the vehicle into custody.
Section A Requirements	Section A must be completed for vehicles valued at $500 or less, deemed unusable, and lacking a valid marker plate.
Section B Purpose	Section B is used when the municipality transfers ownership of the abandoned vehicle to a junkyard, ensuring proper documentation of the transfer.
Contact Information	The form must be sent to the Department of Motor Vehicles at 60 State Street, Wethersfield, CT 06161.
Signature Requirement	An authorized municipal official must sign the form, certifying that the vehicle meets the specifications of C.G.S. §14-150(d).
Vehicle Information Needed	Key vehicle details such as year, make/model, vehicle identification number, and location of abandonment must be provided.
Fees Imposed	The form allows for the documentation of any charges imposed by the towing service, ensuring transparency in the process.

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