Connecticut DMV Registration Form

Official Registration of a Motor Vehicle and Application for Certificate of Title

State of Connecticut Department of Motor Vehicles

H-13 Rev. 8-2014

Instructions:

Please print using a black or blue pen.

If required, TITLE must accompany this application.

If you are changing your address in addition to DMV, please contact your local post office to change your official mailing address.

COM. CARRIER-US DOT NO. (If assigned)

DMV OFFICE USE ONLY / TOTAL FEE $

1. OWNER

OWNER'S NAME (Last, First, Middle Initial)

OWNER'S SEX M F    OWNER'S BIRTHDATE    OWNER'S LICENSE NO. OR ID

MAILING ADDRESS (Number and Street)

CITY OR TOWN STATE ZIP CODE

CT RESIDENT YES NO    RESIDENT ADDRESS (If different from mailing address)

CO-OWNER'S NAME (If any)    CO-OWNER'S SEX M F

CO-OWNER'S BIRTHDATE    CO-OWNER'S LICENSE NO. OR ID

IF CO-OWNERSHIP JOINT/OR COMMON/AND

IS OWNER A BUSINESS YES NO    INITIALS

CT TOWN & STREET ADDRESS WHERE VEHICLE IN THE NORMAL COURSE OF OPERATION MOST FREQUENTLY LEAVES FROM, RETURNS TO OR REMAINS

2. LEASED VEHICLE

NAME OF LESSEE (Person to whom or company to which vehicle is leased)    LESSEE OPERATOR LICENSE NO.

CONNECTICUT LEASING LICENSE NO.

ADDRESS OF LESSEE

3. VEHICLE REGISTRATION

VEHICLE I.D. NUMBER    YEAR    MAKE

MODEL NAME OR NO.    BODY STYLE

FUEL TYPE    CYLINDERS    NO. OF WHEELS

COLOR (Maximum of Two)    ODOMETER READING (Mileage)

NEW OR USED NEW USED    COMMERCIAL USE YES NO

4. IF OTHER THAN PASSENGER STYLE VEHICLE

LIGHT WEIGHT (Wt. empty)    NO. AXLES    SEAT CAPACITY    NO. STANDEES

CARRY SCHOOL CHILDREN? YES NO    COM. CARRIER-US DOT NO. (If assigned)

GROSS WEIGHT (Light wt. + max load)    GROSS VEHICLE WT. RATING    HAZARDOUS MATERIAL YES NO

INTERSTATE COMMERCE YES NO    TRAILERS - Rear lights required...

5. LIEN-HOLDER

LIEN-HOLDER FINANCING VEHICLE PURCHASE FOR CURRENT OWNER YES NO    DATE OF LIEN

SECOND LIEN-HOLDER (If Any)    DATE OF SECOND LIEN

ADDRESS OF LIEN-HOLDER

ADDRESS OF SECOND LIEN-HOLDER

6. SELLER(S)

NAME OF SELLER(S)    DATE VEHICLE PURCHASED

SELLER'S ADDRESS

PURCHASE PRICE (Bill of Sale required)

7. TAX EXEMPTION

IF TAX EXEMPTION IS CLAIMED YES NO    CODE NO.

EXEMPTION INFORMATION

TAXABLE PRICE    HIGHEST FEE PAID    RESTRICTION CODE

8. DEALER TRANSACTION

IDENTIFICATION NUMBER OF TRADED-IN VEHICLE    YEAR    MAKE

CT DEALER LIC. NO.    CT SALES TAX PERMIT NO.

TOTAL SALES PRICE    TRADE-IN ALLOWANCE    NET SALES PRICE

STATE TAX COLLECTED    DEALER SIGNATURE    DATE SIGNED

9. OWNER'S SIGNATURE

DMV OFFICE USE ONLY

NEW ISSUE    TRANSFER    TEMP. CERT.    SUB. REG.

EMISSIONS    INFO. CHANGE    SALES TAX    ADMIN FEE

Sales or Use Tax Instructions

See page 2 for sales/use tax computation, exemption codes, and additional instructions.

Additional Information