DEPARTMENT OF MOTOR VEHICLES CT LICENSED DEALER VEHICLE INSPECTION FORM STATE OF CONNECTICUT

CT LICENSED DEALER
VEHICLE INSPECTION FORM
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
K-208 NEW 10-2012
COMMERCIAL VEHICLE SAFETY DIVISION
This report shall be used by a CT licensed dealer to comply with CGS 14-62(g) and must be completed in its ENTIRETY.
Before offering any used motor vehicle for retail sale, the selling dealer shall complete a comprehensive safety inspection of such vehicle.
VEHICLE INFORMATION
YEAR
MODEL
MAKE
BODY STYLE
MILEAGE
VIN
NUMBER
DEALER LICENSE INFORMATION
NAME OF DEALER
PHONE NUMBER
ADDRESS
TOWN/CITY
STATE
PRINCIPAL
DEALER LICENSE NUMBER
DEALER
MUST INITIAL
A, B or C
INSPECTION
RESULTS
INSPECTION ITEM
ZIP CODE
PASS
FAIL
A
This vehicle is deemed to be in condition for legal operation on any highway of this state and may be
covered by a warranty.
B
This vehicle is deemed to be in condition for legal operation on any highway of this state, but is being
sold 'AS IS', and is not subject to warranty under CGS 42-224.
C
This vehicle is NOT in condition for legal operation on the highways of Connecticut and is being sold
in 'AS IS' condition with the defects noted below. There is NO warranty.
BUYER NAME PRINT
BUYER SIGNATURE AND DATE
Explanation of Defects or Repairs Needed
SERVICE BRAKES
PARKING BRAKE
TIRES/WHEELS
STEERING SYSTEM
SUSPENSION
FRAME/CHASSIS
EXHAUST
FUEL SYSTEM
HEADLIGHTS
STOP/TURN LIGHTS
MISC. LIGHTS
WIPERS/WASHER
WINDSHIELD, TINT
HORN
VIN VERIFIED
MIRRORS
SEAT BELTS
AIR BAGS
EMISSIONS
Vehicle shall be emissions compliant per 14-164c(n)
INSPECTION CERTIFICATION - MUST BE SIGNED BY LICENSEE
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, 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 false written
statement which I do not believe to be true, with the intent to mislead a public servant, I will be subject to prosecution under the above cited laws.
LICENSEE SIGNATURE AND PRINTED NAME
DATE
X
A COPY OF THIS DOCUMENT MUST BE PROVIDED TO THE BUYER