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The Connecticut H 110 form serves a crucial role in the process of notifying former vehicle owners about the sale of abandoned motor vehicles. This form, officially titled "Abandoned Motor Vehicle Sale Notification," is essential for compliance with state regulations concerning abandoned vehicles. It requires detailed information about the vehicle, including its make, model, color, and vehicle identification number. Additionally, the form asks for the odometer reading and an approximate value of the vehicle, categorizing it as either $1,500 or less or over that amount. Sellers must also indicate whether a notice of intent to sell was sent to the owner of record. Alongside this information, the form collects data about the dealer or repairer involved, including their address and license number. It also outlines any storage, towing, or repair charges that may apply, culminating in a total of all associated costs. Finally, the seller must affirm that they have mailed the notification to the previous owner and have met all legal obligations, signing the form under penalty of false statement. This process not only ensures transparency but also protects the rights of former owners while facilitating the sale of abandoned vehicles in Connecticut.

Connecticut H 110 Example

STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
TITLE SECTION
60 STATE STREET, WETHERSFIELD, CT 06161
On The Web at ct.gov/dmv

ABANDONED MOTOR VEHICLE SALE NOTIFICATION

H-110 REV. 3-2016

INSTRUCTIONS:

1. Print clearly or type.

2.Attach H-110 to the Affidavit of Compliance (H-76)

3.Mail copy to former owner of record.

YEAR

MAKE/MODEL

ODOMETER READING

COLOR

VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

APPROXIMATE VALUE OF VEHICLE

 

 

 

 

 

 

 

 

 

 

 

$1500 OR LESS

OVER $1500

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

WAS NOTICE OF INTENT TO SELL SENT TO OWNER?

OWNER OF

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RECORD

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF DEALER/REPAIRER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SELLER

ADDRESS OF DEALER/REPAIRER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE VEHICLE PLACED IN CUSTODY OF DEALER/REPAIRER

 

DEALER/REPAIRER LICENSE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STORAGE CHARGES (If any)

 

 

TOWING CHARGES (If any)

 

 

REPAIR CHARGES (If any)

 

 

 

LIEN

$

 

 

 

 

 

$

 

 

 

 

 

INFORMATION

OTHER CHARGES (If any, specify)

 

 

 

 

 

 

TOTAL OF ALL CHARGES

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

NAME (Owner)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

PURCHASER(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF SALE

PLACE OF SALE

 

 

 

 

 

 

 

SALES PRICE

 

 

 

 

 

 

 

 

 

 

$

 

 

 

I have mailed this notification to the former owner of record identified above and have complied with all relevant legal requirements. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, under penalties 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.

SIGNATURE OF SELLER

X

DATE SIGNED

Document Specifications

Fact Name Description
Purpose The H-110 form is used to notify the former owner of an abandoned motor vehicle sale in Connecticut.
Governing Laws The form is governed by Section 14-110 and Section 53a-157b of the Connecticut General Statutes.
Submission Requirements It must be printed clearly or typed and attached to the Affidavit of Compliance (H-76).
Notification A copy of the H-110 must be mailed to the former owner of record.
Vehicle Information Details such as year, make/model, odometer reading, color, and VIN must be included.
Charges Storage, towing, repair, and other charges must be itemized and totaled on the form.
Signature Requirement The seller must sign the form, affirming compliance with legal requirements under penalty of false statement.
Sale Details The form captures the purchaser's name, date of sale, place of sale, and sales price.
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