1 CONNECTICUT REGISTRATION AND STATE OF CONNECTICUT DMV USE ONLY - TEMPORARY PLATE NUMBER TITLE APPLICATION DEPARTMENT OF MOTOR VEHICLES H-13B REV. 6-2018 60 STATE STREET, WETHERSFIELD, CT 06161 INSTRUCTIONS: http://www.ct.gov/dmv DMV USE ONLY - PERMANENT PLATE NUMBER (1) Please print using a black or blue pen. (2) Fill out the applicable sections of this form. (3) Use the DMV website to check for all documents required to complete your transaction and for any outstanding compliance issues. OWNER'S BIRTHDATE OWNER'S (APPLICANT'S) NAME (Last, First, Middle Initial) OWNER SECTION 1 (APPLICANT) SECRETARY OF STATE NO. (Optional) STATE WHERE ISSUED PHONE NUMBER (If Applicable) OWNER'S LICENSE OR ID NUMBER (Check one) IF CO-OWNERSHIP (Last, First, Middle Initial) CO-OWNER'S (CO-APPLICANT'S) NAME CO-OWNER'S BIRTHDATE - JOINT/OR Requires ONE signature to transfer ownership - Requires ALL COMMON/AND (If Applicable) PHONE NUMBER (Optional) STATE WHERE ISSUED SECRETARY OF STATE NO. CO-OWNER'S LICENSE OR ID NUMBER signatures to transfer ownership OWNER'S MAILING ADDRESS (Number and Street, and Apartment No. if applicable) (Zip Code) (City or Town) (State) (If Different from Mailing Address - PO Box is NOT acceptable. Please include Apartment No. if applicable) RESIDENT ADDRESS CT RESIDENT? NO YES IF DIFFERENT FROM RESIDENT ADDRESS, INDICATE HERE CHECK BOX IF RESIDENT ADDRESS IS WHERE (Number and Street, Apartment No.) (Zip Code) (State) (City or Town) VEHICLE MOST FREQUENTLY LEAVES FROM, RETURNS TO, OR REMAINS (For Property Tax) YEAR VEHICLE I.D. NUMBER MODEL NAME OR NO. BODY STYLE (4-Dr. Sedan, etc.) MAKE VEHICLE 2 INFORMATION NEW OR USED? (Gas, Diesel, etc.) FUEL TYPE (Maximum of Two) COLOR(S) NO. OF WHEELS ODOMETER READING If Commercial use, CYLINDERS or CC's (Mileage) Combination use or Pick-Up NEW USED Truck Complete Section 8 SELLING PRICE (Purchased) DATE VEHICLE SOLD (If 2 owners, include both names) NAME OF SELLER(S) SELLER'S 3 INFORMATION (Number and Street) SELLER'S ADDRESS (City or Town) (State) (Zip Code) DATE OF LIEN NAME OF LIEN-HOLDER SECURITY INTEREST - 4 Loan or Lien Information (State) (City or Town) (Number and Street) (Zip Code) ADDRESS OF LIEN-HOLDER (State) (City or Town) DATE OF SECOND LIEN NAME AND ADDRESS OF SECOND LIEN-HOLDER (Number and Street) (Zip Code) TAX IF TAX EXEMPTION IS CLAIMED READ THE REVERSE SIDE OF THIS FORM AND SPECIFY THE CODE ASSOCIATED WITH THE TAX 5 EXEMPTION AND ANY ADDITIONAL INFORMATION THAT YOU CAN PROVIDE. EXEMPTION IF CODE #3, LIST TOTAL SALES TAX PAID TO OTHER CODE NO. FROM BACK OF FORM EXEMPTION INFORMATION (If leased vehicle lessor tax number if applicable) JURISDICTION $ The undersigned certifies that there are no liens on this vehicle except those specified above. The insurance required by Connecticut law is in effect and will be maintained during this registration period. All property taxes due any CT Taxing Authority for any vehicle previously registered in my/our name(s) have been paid. If other than Passenger registration this vehicle is registered in OWNER accordance with Manufacturer's Maximum Gross Vehicle Weight Rating. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty 6 SIGNATURE(S) 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. DATE SIGNED DATE SIGNED CO-OWNER'S SIGNATURE OWNER'S SIGNATURE X X ADDENDUM - If Additional Information is needed for your transaction, please complete the applicable sections below (Person to whom or company to which vehicle is leased) OPERATOR LIC. NO. AND STATE OF LESSEE NAME OF LESSEE LEASED VEHICLE 7 INFORMATION (State) ADDRESS OF LESSEE (City or Town) (P.O. Box is Not Acceptable) (Number and Street) (Zip Code) NAME OF CO-LESSEE (Person to whom or company to which vehicle is leased) OPERATOR LIC. NO. AND STATE OF CO-LESSEE MANUFACTURER'S GROSS VEHICLE WEIGHT RATING LIGHT WEIGHT (Wt. empty) (Light wt. + max load) GROSS WEIGHT (Declared Weight) OTHER THAN A PASSENGER 8 STYLE MOTOR VEHICLE COM. CARRIER-US DOT NO. CARRY SCHOOL CHILDREN? NO. AXLES SEAT CAPACITY NO. STANDEES (If assigned) COMPLETE FOR APPLICABLE YES NO (Buses, Trucks) VEHICLES HAZARDOUS MATERIAL? INTERSTATE COMMERCE? USED FOR THE TRAILERS - Rear lights required. Brakes required if 3,000 lbs. or more GVWR. TRANSPORTATION NO YES NO YES NO YES Length of vehicle & trailer combined must be in accordance with CGS 14-262. ? (BOAT) OF A VESSEL YEAR VEHICLE I.D. NUMBER OF TRADED-IN VEHICLE MODEL MAKE DEALER 9 TRANSACTION NET SALES PRICE TRADE-IN ALLOWANCE CONNECTICUT SALES TAX PERMIT NO. STATE TAX COLLECTED TOTAL SALES PRICE The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in accordance with provisions of Section 14-110 & 53a-157b of the Connecticut General Statutes. CONNECTICUT DEALER LICENSE NUMBER DEALER SIGNATURE (Authorized Representative) DATE SIGNED X
2 SALES TAX INSTRUCTIONS SALES OR USE TAX COMPUTATION - The sales or use tax is based on the invoiced purchase price for vehicles purchased from a licensed dealer. If A) the vehicle is purchased from a private individual, not from a licensed dealer, the sales or use tax is based on the current month's issue of the N.A.D.A. Official Used Car Guide, Eastern Edition or the Bill of Sale, whichever is greater. SALES TAX PAID IN ANOTHER STATE - In order to obtain credit for sales/use tax paid to another jurisdiction, you must present proof of payment in B) the form of an official receipt or dealer's invoice. When two individuals trade vehicles, each must pay sales/use tax on the value of the vehicle received based on the current BARTER, TRADE, SWAP - C) month's issue of the N.A.D.A. Official Used Car Guide, Eastern Edition. CHECKS - Please make your check payable to "DMV". The total for all DMV fees also will include the sales tax. D) Claims for sales or use tax refunds must be submitted to the Department of Revenue Services. Use CERT-106, Claim for Refund of Use REFUNDS - E) Tax Paid on Motor Vehicle Purchased from Other Than a Motor Vehicle Dealer , to claim a refund of use tax paid on a motor vehicle purchased from other than a motor vehicle dealer. A CERT-106 form is available at all DMV branches. All other claims for refund, with supporting documents, must be directed to the Department of Revenue Services, Refunds, Public Services Unit, 450 Columbus Boulevard, Suite 1, Hartford, CT 06103. SPECIAL INSTRUCTIONS FOR THOSE CLAIMING EXEMPTION FROM CONNECTICUT SALES OR USE TAX Specify the applicable code (1, 2, 3, 4, or 5) as described below in the space on the front in SECTION 7 labeled TAX EXEMPTION. Include additional as required below for the applicable code in the area labeled EXEMPTION INFORMATION. information (Only MOTHER, FATHER, SPOUSE (wife, husband, civil union) Transfer between immediate family members , DAUGHTER, SON, Code 1: SISTER or BROTHER qualify as "immediate family members"). Specify code "1" and in the area labeled EXEMPTION INFORMATION, write which of the above-listed relationships describes the person from whom you obtained the vehicle. Specify the state in which this immediate family member previously registered the vehicle. In order to qualify for this exemption, the vehicle must have been registered in this immediate family member's name for at least 60 days. Sale to a Connecticut exempt organization or to a governmental agency. Specify code "2" and write the Connecticut Tax Exemption Code 2: Number beginning with "E" in the area labeled EXEMPTION INFORMATION or attach a copy of the organization's Internal Revenue Code Section 501(c)(3) or 501(c)(13) exemption letter issued by the IRS. Code 3: Sales or Use Tax was paid to another jurisdiction. An official receipt or dealer's invoice must be presented identifying the amount of sales tax paid. Specify code "3" and, in the area labeled EXEMPTION INFORMATION, write the amount of tax paid and the jurisdiction to which this tax was paid. Code 4: Out-of-state registration or photocopy is required. Vehicles should have Vehicles purchased while residing outside of Connecticut. been registered out-of-state at least 30 days prior to application for Connecticut registration. Specify code "4" and, in the area labeled EXEMPTION INFORMATION, write in order (1) the state in which you were residing when you purchased vehicle, (2) the date the vehicle was purchased, (3) the date the vehicle was registered in that state, and (4) the date the vehicle was first moved to Connecticut. Code 5: Specify code "5" and write the applicable letter from the list below in the area labeled EXEMPTION INFORMATION. Other reasons. 5A) GIFT - If vehicle was received as a gift, provide a copy of form AU-463, "Motor Vehicle and Vessel Gift Declaration". These forms are available at all DMV offices. 5B) VEHICLE PURCHASED BY A LESSOR EXCLUSIVELY FOR LEASE OR RENTAL - Provide the Connecticut Tax Registration Number of the lessor/purchaser. 5C) SALE BY A FEDERAL AGENCY, FEDERAL CREDIT UNION OR AMERICAN RED CROSS - Vehicle must have been obtained from a Federal Agency, a Federal Credit Union or the American Red Cross. 5D) - Acquiring a vehicle in connection with the organization, CORPORATE ORGANIZATION, REORGANIZATION OR LIQUIDATION reorganization or liquidation of an incorporated business provided (a) the last taxable sale, transfer or use of the motor vehicle was subjected to Connecticut sales or use tax, (b) the transferee is the incorporated business or a stockholder thereof. 5E) Acquiring a vehicle in connection with the organization or PARTNERSHIP OR LLC ORGANIZATION OR TERMINATION - termination of a partnership or LLC provided (a) the last taxable sale, transfer or use of the motor vehicle was subjected to Connecticut sales or use tax, and (b) the purchaser is the partnership or limited liability company, as the case may be, or a partner or member, thereof, as the case may be. 5F) - Section 12-412(110) exempts the sale on and after January 1, 2008, and prior to HIGH MPG PASSENGER MOTOR VEHICLES July 1, 2010, of any passenger motor vehicle, as defined in section 14-1, that has a U.S. EPA estimated city or highway gasoline mileage rating of at least 40 miles per gallon. 5G) COMMERCIAL TRUCKS, TRUCK TRACTORS, TRACTORS AND SEMITRAILERS AND VEHICLES USED IN COMBINATION THEREWITH - Section 12-412(70)(A)(i) exempts commercial trucks, truck tractors, tractors and semitrailers and vehicles used in combination therewith which have a gross vehicle weight rating in excess of 26,000 pounds. Section 12-412(70)(A)(ii) exempts commercial trucks, truck tractors, tractors and semitrailers and vehicles used in combination therewith operated actively and exclusively during the period commencing upon its purchase and ending one year after the date of purchase for the carriage of interstate freight pursuant to a certificate or permit issued by the Interstate Commerce Commission (ICC) or its successor agency. Purchaser - please attach a copy of your certificate or permit that was issued by the ICC or its successor agency, and a copy of a properly completed Dept. of Revenue Services CERT-105, Commercial Motor Vehicle Purchased Within Connecticut for Use in the Carriage of Freight in Interstate Commerce. For further information about sales and use taxes, see the DRS website (www.ct.gov/drs) or call DRS during business hours, Monday through Friday: • 1-800-382-9463 (Connecticut calls outside the Greater Hartford calling area only); or • 860-297-5962 (from anywhere). TTY, TDD, and Text Telephone users only may transmit inquiries anytime by calling 860-297-4911.
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