Transcription of MOTORIST INFORMATION - Connecticut
1 OUT-OF-STATE VIN VERIFICATION FORMAE-81 Rev. 12-2016 STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLESEMISSIONS DIVISION ROOM 10360 STATE STREETWETHERSFIELD, CT 06161-5510(860) 263-5333 or (860) 263-5611 INSTRUCTIONS:Please fill out all sections completely. The vehicle identification authority section, must be completed andsigned by an out-of-state law enforcement agency INFORMATIONNAMEPHONE NUMBER (Include area code)ADDRESSCELL PHONE NUMBER (Include area code)EMAIL ADDRESS (Optional)OWNER INFORMATION (IF DIFFERENT)NAMEPHONE NUMBER (Include area code)ADDRESSCELL PHONE NUMBER (Include area code)EMAIL ADDRESS (Optional)VEHICLE INFORMATIONMAKEMODELYEARPLATE NUMBERVEHICLE IDENTIFICATION NUMBERVEHICLE IDENTIFICATION AUTHORITY (MUST BE LAW ENFORCEMENT)LOCAL POLICESTATE POLICECAMPUS POLICEMILITARY AUTHORITYMOTOR VEHICLE AUTHORITYDEPARTMENT NAMEPHONE NUMBER (Include area code)
2 ADDRESSAUTHORIZED NAME AND RANKBADGE NUMBERAUTHORIZED SIGNATUREDATE EXAMINED
