CONNECTICUT REGISTRATION AND TITLE APPLICATION …

1 If Commercial use,Combination use or Pick-UpTruck Complete Section 8 DEALERTRANSACTIONOTHER THAN PASSENGERSTYLE MOTOR VEHICLETAXEXEMPTIONLEASED VEHICLEINFORMATIONSECURITY INTEREST -Loan or Lien InformationUS DOT NO. (If assigned) CONNECTICUT REGISTRATION ANDTITLE APPLICATIONH-13B REV. 3-2021 STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLES60 STATE STREET, WETHERSFIELD, CT 06161 :Please print using a black or blue out the applicable sections of this the DMV website to check for all documents required to complete your transaction and for any outstanding compliance 'S (APPLICANT'S) NAME (Last, First, Middle Initial)IF CO-OWNERSHIP (Check one)COMMON/AND - Requires ALLsignatures to transfer ownership(1)(2)(3)CHECK BOX IF RESIDENT ADDRESS IS WHEREVEHICLE MOST FREQUENTLY LEAVES FROM,RETURNS TO, OR REMAINS (For Property Tax)OWNER'S MAILING ADDRESS (Number and Street, and Apartment No.)

2 If applicable)VEHICLE NUMBERCOLOR(S) (Maximum of Two)MODEL NAME OR TYPE (Gas, Diesel, etc.)BODY STYLE (4-Dr. Sedan, etc.)NEW OR USED?NEWUSEDIF TAX EXEMPTION IS CLAIMED READ THE REVERSE SIDE OF THIS FORM AND SPECIFY THE CODE ASSOCIATED WITH THE TAXEXEMPTION AND ANY ADDITIONAL INFORMATION THAT YOU CAN NO. FROM BACK OF FORMEXEMPTION INFORMATION (If leased vehicle lessor tax number if applicable)NAME OF SELLER(S) (If 2 owners, include both names)ADDRESS OF LESSEE ( Box is Not Acceptable)NAME OF LESSEE (Person to whom or company to which vehicle is leased)NAME OF LIEN-HOLDERDATE OF LIEN(Number and Street)(City or Town)(State)(Zip Code)OWNER'S SIGNATURECO-OWNER'S SIGNATUREThe undersigned certifies that there are no liens on this vehicle except those specified above.

3 The insurance required by CONNECTICUT law is in effect and will be maintained during this registrationperiod. 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 inaccordance 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 penaltyof false statement, in accordance with the provisions of Section 14-110 and 53a-157b of the CONNECTICUT General Statutes.

4 I understand that if I make a statement which I do not believe to be true, withthe intent to mislead the Commissioner, I will be subject to prosecution under the above-cited - Requires ONEsignature to transfer ownershipNAME AND ADDRESS OF SECOND LIEN-HOLDER (Number and Street)LIGHT WEIGHT (Wt. empty)COMPLETE FOR APPLICABLEVEHICLES (Buses, Trucks)TRAILERS - Rear lights required. Brakes required if 3,000 lbs. or more of vehicle & trailer combined must be in accordance with CGS CAPACITYNO. STANDEESNO. AXLESCARRY SCHOOL CHILDREN?YESNOMFTR. GVWRGROSS WEIGHT (Declared Wt.)

5 (Lt. wt.+max load)OPERATOR LIC. NO. AND STATE OF LESSEEOWNER'S BIRTHDATEOWNER'S LICENSE OR ID NUMBERCYLINDERS or CC'sODOMETER READING (Mileage)HAZARDOUS MATERIAL?YESNOSELLER'S ADDRESS (Number and Street)DATE VEHICLE SOLD (Purchased)SELLING PRICE(City or Town)(Zip Code)INTERSTATE COMMERCE?RESIDENT ADDRESS (If Different from Mailing Address - PO Box is NOT acceptable. Please include Apartment No. if applicable)DATE SIGNEDDATE SIGNEDCT RESIDENT?YESNO1 OWNER SECTION(APPLICANT)CO-OWNER'S (CO-APPLICANT'S) NAME (Last, First, Middle Initial)CO-OWNER'S BIRTHDATE2 VEHICLEINFORMATIONNO.

6 OF WHEELS4 ADDRESS OF LIEN-HOLDER (Number and Street)(City or Town)(State)(Zip Code)DATE OF SECOND LIEN(City or Town)(State)(Zip Code)7 NAME OF CO-LESSEE (Person to whom or company to which vehicle is leased)OPERATOR LIC. NO. AND STATE OF CO-LESSEE3 SELLER'SINFORMATION(City or Town)(State)(Zip Code)5 DMV USE ONLY - PERMANENT PLATE NUMBER6 OWNERSIGNATURE(S)ADDENDUM - If Additional Information is needed for your transaction, please complete the applicable sections belowYESNO89 VEHICLE NUMBER OF TRADED-IN VEHICLEYEARMAKEMODELCONNECTICUT DEALER LICENSE NUMBERDEALER SIGNATURE (Authorized Representative)DATE SIGNEDXCONNECTICUT SALES TAX PERMIT SALES PRICETRADE-IN ALLOWANCENET SALES PRICESTATE TAX COLLECTEDIF DIFFERENT FROM RESIDENT ADDRESS, INDICATE HERE(City or Town)

7 (State)(State)(Zip Code)(Number and Street, Apartment No.)DMV USE ONLY - TEMPORARY PLATE NUMBERPHONE NUMBER (Optional)PHONE NUMBER (Optional)ISSUING STATESEC OF STATE/BUSINESS ID NO. (If Applicable)CO-OWNER'S LICENSE OR ID NUMBERISSUING STATEIF CODE #3, LIST TOTAL SALES TAX PAID TO OTHERJURISDICTION$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 FOR THETRANSPORTATIONOF A VESSEL (BOAT)?

8 YESNOSEC OF STATE/BUSINESS ID NO. (If Applicable)IF DOT #, HAS THEVEHICLE BEENINSPECTED?Ref 49 CFR WEIGHTDECLARED REQUIRESCT DOT OS/OW PERMITYESSALES OR USE TAX COMPUTATION - The sales or use tax is based on the invoiced purchase price for vehicles purchased from a licensed dealer. Ifthe 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 Used Car Guide, Eastern Edition or the Bill of Sale, whichever is TAX PAID IN ANOTHER STATE - In order to obtain credit for sales/use tax paid to another jurisdiction, you must present proof of payment inthe form of an official receipt or dealer's , TRADE, SWAP - When two individuals trade vehicles.

9 Each must pay sales/use tax on the value of the vehicle received based on the currentmonth's issue of the Official Used Car Guide, Eastern - Please make your check payable to "DMV". The total for all DMV fees also will include the sales - Claims for sales or use tax refunds must be submitted to the Department of Revenue Services. Use cert -106, Claim for Refund of UseTax 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 fromother than a motor vehicle dealer. A cert -106 form is available at all DMV branches.

10 All other claims for refund, with supporting documents, must bedirected to the Department of Revenue Services, Refunds-RCA Audit Group, 450 Columbus Boulevard, Suite 1, Hartford, CT )B)C)D)E)SALES TAX INSTRUCTIONSSPECIAL INSTRUCTIONS FOR THOSE CLAIMING EXEMPTION FROM CONNECTICUT SALES OR USE TAXS pecify the applicable code (1, 2, 3, 4, or 5) as described below in the space on the front in SECTION 5 labeled TAX EXEMPTION. Include additionalinformation as required below for the applicable code in the area labeled EXEMPTION between immediate family members (Only MOTHER, FATHER, SPOUSE (wife, husband, civil union), DAUGHTER, SON,SISTER or BROTHER qualify as "immediate family members").