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Get CT H-6B 2019-2024

APPLICATION FOR REPLACEMENT CERTIFICATE OF TITLE AND OWNERSHIP TRANSFER IN ABSENCE OF TITLE H-6B REV. 10-12 INSTRUCTIONS WHO MAY APPLY HOW TO COMPLETE 1. The owner or legal representative with proper identification required may apply for a replacement certificate of title if no lienholder was listed on the original certificate of title. 1. Please print in ink or type. Strikeovers or. erasures are not acceptable. 2. If a lien is listed on the title proof of satisfaction lien release must be submitted with this form* Request will not be processed without a lien release. 3. If a lien is still outstanding the lienholder shall apply for a replacement certificate of title with a power of attorney. 2. For a replacement title fill in a Section 1 - Vehicle and title information b Section 3 - Applicant s Signature c If lien on title include lien release fill in b Section 2 - Ownership transfer FEE 25. 00 WARNING Federal law requires that you state the mileage in connection with a transfer of ownership* Failure to complete the Odometer Disclosure Statement or providing a false statement may result in fines and/or imprisonment. Make check payable to DMV VOID UNLESS VALIDATED ABOVE BY DMV TO State of Connecticut Department of Motor Vehicles 60 State Street Wethersfield CT 06161-5520 REASON FOR APPLICATION Check one OWNERSHIP TRANSFER SECTION VEHICLE AND TITLE INFORMATION HERE TITLE NUMBER If available IF REQUESTING REPLACEMENT TITLE Check one below REPLACEMENT TITLE LOST REG* PLATE NUMBER STOLEN MUTILATED Please attach VEHICLE IDENTIFICATION NUMBER DESTROYED MAKE YEAR NAME S OF OWNER S AS ON TITLE Last First Middle Initial AND ADDRESS Number and Street City or Town State Zip Code LIENHOLDER ON TITLE Name and Address IF YOUR LIEN Loan HAS BEEN SATISFIED PLEASE SUBMIT A LETTER FROM THE LIENHOLDER STATING SUCH. I state that to the best of my knowledge and belief the odometer reading specified below reflects the actual mileage unless one of the following statements is checked* ODOMETER READING No tenths OWNERSHIP TRANSFER AND ODOMETER STATEMENT I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. The odometer started at zero again* NAME OF BUYER Please Print CHECK ONE IF CO-OWNED OR Common Joint DEALER S LICENSE NO. if dealer ADDRESS OF BUYER S SIGNATURE OF BUYER S Or authorized official PRINTED NAME OF BUYER S Or authorized official TRANSFER DATE x 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 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. SELLER S The undersigned seller s hereby state s that the vehicle described on this application was transferred to the buyer s specified above.

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