Form K-174 - Received Junk Vehicles Report
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1RECEIVED JUNK VEHICLES REPORT
K-174 REV. 3-05
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
BUREAU OF SAFETY AND ENFORCEMENT
DEALERS AND REPAIRERS
INSTRUCTIONS:
A list of all motor vehicles received must be submitted twice monthly to the Department of Motor Vehicles, per C.G.S. 14-67m(a).
1.
FIRST REPORT: Due by the 20th of each month to cover the first 15 days of the current month.
SECOND REPORT: Due by the 5th of each month to cover the 16th through the last day of the previous month.
Surrendered CERTIFICATE OF TITLES must accompany this list. A Title vehicle must not be received unless the Title is surrendered with the vehicle.
2.
A report is required for each reporting period even if no vehicles were received.
3.
Indicate the type of ownership document used by abbreviating the type of document received:
4.
T-Title, A-Aba Paper, B-Bill of Sale (pre 1970 Vehicles), H-H-109 Form, D-H-6B Lost or Duplicate Title.
TO: Department of Motor Vehicles, Dealers and Repairers, 60 State Street, Wethersfield, Connecticut 06161-2010
MONTH
YEAR
Check ( Ö ) if no vehicles were
REPORTING
First (1st) thru fifteenth (15th) of:
PERIOD
received during this reporting
Sixteenth (16th) thru last day of:
period.
(Check one)
BUSINESS NAME (As appears on Recycler's License)
LICENSE NUMBER
BUSINESS
INFORMATION
BUSINESS ADDRESS
TELEPHONE NUMBER
MAKE OF VEHICLE
YEAR
ENGINE NUMBER (if any)
VEHICLE IDENTIFICATION NUMBER OWNERSHIP DOCUMENT
STATE
SIGNATURE OF AUTHORIZED OFFICIAL (Service Manager or Designee)
TITLE OF AUTHORIZED OFFICIAL
DATE SIGNED
DISTRIBUTION:
White - DMV
Canary - Licensee
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