Official Connecticut H 110 Template in PDF
Structure
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
ABANDONED MOTOR VEHICLE SALE NOTIFICATION
H-110 Rev 06-2026
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS UNIT
60 STATE ST, WETHERSFIELD, CT 06161
On the Web at ct.gov/dmv
1. Type or clearly print the required information in the fields.
2. If funds are placed in escrow, report the escrow amount and the
date such funds were placed in escrow.
3. Email a copy of the completed H-110 Form, along with a copy of
the sale receipt, to DMV.reportsale@ct.gov.
VEHICLE
INFORMATION
YEAR
MAKE MODEL
ODOMETER READING
COLOR
VEHICLE IDENTIFICATION NUMBER
WAS THE NOTICE OF INTENT TO SELL SENT TO THE OWNER AND LIENHOLDER OF RECORD ?
YES
NO
SELLER
INFORMATION
NAME OF WRECKER SERVICE
ADDRESS OF WRECKER SERVICE
WRECKER SERVICE LICENSE NUMBER
LIEN
INFORMATION
STORAGE CHARGES (if any)
TOWING CHARGES (if any)
REPAIR CHARGES (if any)
$
$
$
OTHER CHARGES (if any, specify)
TOTAL OF ALL CHARGES
FUNDS PLACED IN ESCROW- ENTER "0" IF NONE
Date
$
$
$
PURCHASER(S)
NAME (Owner)
ADDRESS
DATE OF SALE
PLACE OF SALE
SALE PRICE
$
The information provided to the Commissioner of Motor Vehicles herein is
subscribed by me, under penalty of false statement, in accordance with the
provisions of 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.
SIGNATURE OF SELLER
DATE SIGNED
X
NOTIFICATIONS
4. Provide the original form to the purchaser of the vehicle at the time of sale.
5. If the owner collects the escrowed funds, submit the H-110A form to report
the sale within 15 days to DMV.reportsale@ct.gov.
6 If the funds remain unclaimed for one year from the sale date of the motor
vehicle, submit H-110A Form to DMV.reportsale@ct.gov.
Instructions:
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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