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MOTOR VEHICLE TAX CREDIT APPLICATION
Sec. 12-71C Connecticut General Statutes
For Vehicles Sold, Destroyed, or Stolen and Not Replaced.
Date___________________ List Year___________ Account Number___________________
Name__________________________________ Address________________________________
__________________________________ ________________________________
__________________________________ ________________________________
Make___________ Year_____ Registration Number_______________ I.D._________________
Date vehicle was disposed of _________________________
Sold _______ Destroyed_______ **Re-registered out of State ______
Has this vehicle been replaced? Yes _____ No _____. A vehicle is considered replaced if another
vehicle was purchased within 45 days and the same license plate was used. If YES, the total
original July bill is due in full. If NO, you must include a copy of the plate return receipt
with this form showing that the plate has been returned to the State D.M.V.
_____________________
(Signature of Owner)
The above named applicant deposes and says that the above statements are true and complete.
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(Assessor’s Certification)
Documentation verified __________ Supplemental List Checked__________
Number of taxable months ________
Original Assessments _______________________ X Percentage = Adjusted Assessment
__________________________________ $________________
Linda I. Arnold, Town Assessor
Note: In order to qualify for credit this form must be filled out and returned to this office
along with acceptable proof verifying disposition of vehicle, by the end of the calendar year,
two (2) years after the assessment date in which the credit situation occurred.
For Example: October 1, 2005 = December 31, 2007
October 1, 2006 = December 31, 2008
** Only proof acceptable is copy of registration in new State, by such person who concurrently
ceases to be a resident of Connecticut.
TOWN OF FARMINGTON ASSESSORS OFFICE
FARMINGTON, CT 06032
APPLICATION FOR MOTOR VEHICLE PROPERTY TAX ADJUSTMENT
BASED ON DMV “REGISTRATION PLATE RECEIPT”
YEAR:_______ MAKE: _____________________ VEHICLE ID#:_________________
Registration Plate Number:_________________
I hereby apply for an adjustment to my motor vehicle property taxes based on the
attached “Registration Plate Receipt” from the Connecticut Department of Motor
Vehicles. I no longer own the above-described vehicle and I apply for a property Tax
adjustment based on the date that I cancelled my vehicle registration, which is stated on
the attached “Registration Plate Receipt.” I declare that the information supplied on this
receipt and the information supplied by me above is true and complete. I declare that, I,
in no way, have tried to evade property tax. By my signature below, I accept all
responsibility for, and I agree to pay, all property taxes interest and penalties that result if
the Town Assessor of the Town of Farmington receives documentation which shows that
the information contained on this “Registration Plate Receipt”, or the information that I
have provided above, is not accurate.
Owner’s Signature:_________________________________ Date:__________________
(If signed by person other than the owner)
Authorized by owner: PRINT NAME________________________ Phone:___________
Authorized Signature:________________________________ Date:_________________
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PLEASE NOTE:
The DMV “Registration Plate Receipt” will not be acceptable if any of the following is
missing from the “Registration Plate Receipt”. The receipt must clearly have:
1. Registration Plate Number
2. Cancellation was requested
3. Dates plates were returned and registration cancelled
4. Validated (stamped) by DMV
Required Documentation
For
Motor Vehicle Assessment Changes
Two Substantiating Documents must be submitted to the Assessor
The documentation must be official and specific. Only these forms of proof are
acceptable. NOTE: all forms of proof must be dated and specifically identify the
vehicle in question by make, year and identification number (VIN).
1. Plate receipt from the Department of Motor Vehicles (DMV) indication that
the vehicle’s registration has been cancelled, or the vehicle’s registration plate
has been lost or stolen.
2. Any of the following in addition to the plate receipt from the DMV:
(a) A copy of the vehicle’s bill of sale: A bill of sale section is now
included on the bottom of the vehicle owner’s registration form and
transfer information must be recorded on the back of said form before
it is submitted to the DMV. It is, therefore, the seller’s obligation to
provide a copy of the signed registration form along with the plate
receipt to the assessor.
(b) A copy of the vehicle’s Transfer of Title: The seller must provide the
assessor with a copy of the signed Transfer of Title and the plate
receipt.
(c) Out of State Registration: Proof of residency in another state and a
copy of the vehicle’s registration showing the date the vehicle was
registered in that state, must be provided to the assessor along with the
plate receipt.
(d) Stolen Vehicle: A statement from the vehicle owner’s insurance
company indicating that the vehicle was stolen and not recovered. The
vehicle’s owner must file a lost or stolen plate form with the DMV, a
copy of which must be provided to the assessor.
(e) Totaled Vehicle: A statement from the vehicle owner’s insurance
company indicating that the vehicle was totaled. If the vehicle’s owner
did not return the plate to the DMV, he or she must file a lost or stolen
plate form with the DMV, a copy of which must be provided to the
assessor.
(f) Junked Vehicle: A statement from the junkyard must be provided in
addition to the plate receipt.
(g) Trade-in Vehicle: A copy of the purchase agreement identifying the
trade-in vehicle and its plate receipt must be provided to the assessor.
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