The form that exists for one situation only, and Connecticut prints the limit in a warning at the top of it: this form may be used only when title is physically held by lienholder. When your lender has the certificate and the car is being sold before the paper comes back, the odometer disclosure cannot be made on a document nobody has. The H-117 lets the mileage be disclosed anyway, by appointing the buyer as your attorney-in-fact to write it on the title when it arrives.
Written against H-117 (New 9-2003, from the department's own image of it), issued under 49 CFR 580.13, the federal secure power of attorney for odometer disclosure, administered by the DMV Title Division. Read the warning at the top before anything else. A secure power of attorney used outside the one case it is for is a federal odometer document signed in the wrong circumstances, and the penalties on its own face are fines and imprisonment rather than a rejected application.
There is no download link for the H-117 here because there is not one anywhere - the CT DMV does not publish it. The card below explains where it does come from.
There is no downloadable H-117 to render, because the department does not publish one - it is a three-part secure form with a printed distribution of original, canary and pink copies, issued through the DMV Title Division. The only public picture of it is the department's own image in Chapter 10 of the Dealer Online Manual, which is what the field list on this page is transcribed from.
| On the form | What to put in it |
|---|---|
| Connecticut Dealer License Number | Top right. The form is built around a dealer transaction, and this box is a strong hint about whose form it is. |
| Vehicle Description | Year, make, model, body type and the vehicle identification number, across one row. |
| Part A, Power of Attorney to Disclose Mileage | I [transferor's/seller's name] appoint [transferee's/buyer's name] as my attorney-in-fact, to disclose the mileage, on the title for the vehicle described above, exactly as stated in the following disclosure. |
| I state that the odometer now reads ____ (No Tenths) miles | The reading, with the same two certifications the title carries - mileage in excess of its mechanical limits, or NOT the actual mileage marked WARNING - ODOMETER DISCREPANCY. |
| Part A signatures | Transferor's signature and printed name and address on the left, transferee's signature and printed name and address on the right, and a date of statement. |
| Part B, Power of Attorney to Review Title Documents and Acknowledge Disclosure | The mirror image, and it is invalid unless Part A has been completed: the buyer appoints the seller to sign the mileage disclosure on the title, but only if the disclosure is exactly as the disclosure completed below. |
| Part C, Certification | Signed by whoever exercises the powers of attorney, certifying that the mileage disclosed on the title document is consistent with that provided in the above power of attorney and that, on examining the title and any reassignment documents, the disclosure made is greater than that previously stated. |
| Distribution | Printed at the foot: Original - DMV, Canary - Transferor in Part A, Pink - Dealer. A three-part carbon set, which is another reason it is not a download. |
There is no H-117 to read: the CT DMV does not publish it, so nothing on this page describes its contents beyond what the agency itself says about it — that is here — and what is on the Connecticut Department of Motor Vehicles pages. This is plain-language help with a form, not legal advice, and where our wording and the agency's differ, theirs governs.
Back to all Connecticut seller paperwork, or what selling a car in Connecticut involves.