APPLICATION FOR REPLACEMENT CERTIFICATE OF TITLE
AND OWNERSHIP TRANSFER IN ABSENCE OF TITLE
H-6B REV. 12-15
INSTRUCTIONS
WHO MAY APPLY HOW TO COMPLETE
1. The owner or legal representative (with proper identification 1. Please print in ink or type. (Strikeovers or erasures are not acceptable.)
required) may apply for a replacement certificate of title if no .
lienholder was listed on the original certificate of title. 2. For a replacement title fill in:
a) Section 1 - Vehicle/vessel and title information
2. If a lien is listed on the title, proof of satisfaction (lien b) Section 3 - Applicant's Signature
release) must be submitted with this form. Request will c) If lien on title, include lien release
not be processed without a lien release.
3. For replacement title and ownership transfer fill in:
3. If a lien is still outstanding the lienholder shall apply for a a) Section 1 - Vehicle/vessel and title information
replacement certificate of title with a power of attorney. b) Section 2 - Ownership, Transfer - Must include CT DMV
Supplemental Assignment of Ownership (form Q-1)
c) Section 3 - Applicant's Signature
d) If lien on title, include lien release
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.
TO: State of Connecticut, Department of Motor Vehicles, 60 State Street, Wethersfield, CT 06161-5520
REASON FOR APPLICATION (Check one) IF REQUESTING REPLACEMENT TITLE (Check one below)
OWNERSHIP TRANSFER (MUST INCLUDE FORM Q-1) REPLACEMENT TITLE LOST STOLEN MUTILATED (Please attach) DESTROYED
SECTION TITLE NUMBER (If available) REG. PLATE/VESSEL VEHICLE IDENTIFICATION NUMBER/HULL IDENTIFICATION NUMBER MAKE YEAR
NUMBER
1
VEHICLE
AND TITLE NAME(S) OF OWNER(S) AS ON TITLE (Last, First, Middle Initial) AND ADDRESS (Number and Street, City or Town, State, Zip Code)
INFORMATION
HERE
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. Not valid unless CT DMV Supplemental Assignment of Ownership (form Q-1) is included.
ODOMETER READING (No tenths) I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its
VEHICLE ONLY mechanical limits. (The odometer started at zero again.)
SECTION
2 I hereby certify that the odometer reading is not actual mileage. WARNING: ODOMETER DISCREPANCY
OWNERSHIP
TRANSFER NAME OF BUYER (Please Print) CHECK ONE IF CO-OWNED NAME OF BUYER (Please Print)
AND AND OR
ODOMETER (Common) (Joint)
STATEMENT ADDRESS OF BUYER(S) DEALER'S LICENSE NO. (if dealer)
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. If
joint ownership, the undersigned seller(s) attest(s) that all other living joint owners not signing below have been duly notified of the transfer.
BUYER(S): Do not sign until all sections have been completed and signed by seller(s). Signing indicates that you are aware of the ODOMETER
STATEMENT.
SECTION SIGNATURE (Owner(s), legal representative or lienholder of record) PRINTED NAME(S)
3
APPLICANT'S
SIGNATURE x
NAME OF CUSTOMER REQUESTING INFO CUSTOMER DAYTIME PHONE NUMBER CUSTOMER E-MAIL ADDRESS
CUSTOMER
CONTACT
INFORMATION
IF BY MAIL 1. Submit a check made out to "DMV" for $25.00.
2. Sign the application in Section 3.
DID YOU 3. IF YOU HAD A LIEN ON THE VEHICLE ENCLOSE A LETTER FROM
REMEMBER TO: THE LIENHOLDER STATING THE LIEN WAS SATISFIED (PAID-OFF).
NAME (Last, First, Middle Initial)
ADDRESS (Number and Street)
(City or Town) (State) (Zip Code) W FORWARD TITLE TO:
(Please print or type)
