Whose form is it? Not yours - it is signed by a licensed Connecticut dealer and it exists so the dealer can pay off your loan and take the car before the certificate has come back from your lender. It is on this page because a private seller does sign one corner of it, because it is the document that explains what a dealer means when they say they will "handle the payoff", and because it carries the single most useful sentence in the Connecticut lien set printed across it in the largest type on the sheet.
Written against H-12 (Rev. 8-2003, from the department's own image of it), issued under Conn. Gen. Stat. s. 14-180, resale by a dealer, and s. 14-188 on release of a security interest. This is somebody else's form and the part you sign is an assignment of all your right, title and interest in the vehicle. Do not sign one with the payoff amount left blank, and do not sign one at all unless the counterparty is a licensed Connecticut dealer.
There is no download link for the H-12 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-12 to render because the department does not publish one, and no private seller could complete it in any case - three of its four sections belong to a licensed dealer and the fourth requires a dealer licence number. The field list on this page is transcribed from the department's own image of the form in Chapter 10 of the Dealer Online Manual.
| On the form | What to put in it |
|---|---|
| Instructions, six numbered steps | The sequence the form describes: the titled owner arranges the sale and provides the dealer with the name of the lienholder; the dealer obtains the balance due and the form is completed and signed by the owner; form H-117 must be executed to meet the federal odometer requirement; the dealer forwards a photocopy of both forms to the lienholder with payment; the lienholder releases the lien and forwards the title to the dealer; at resale the dealer completes the reassignment on the reverse of the certificate. |
| Section 1, Vehicle Information | Make, model, year, title number and the vehicle identification number. |
| Section 2, Lienholder Information | The name and address of the institution that holds the paper. |
| Section 3, Purchaser/Transferee Information | The dealer's name and address. On this form the dealer is the transferee, not the buyer. |
| The authorisation paragraph | For value received, the undersigned seller(s) have assigned, transferred, and conveyed all my/our right, title, and interest in the above described motor vehicle subject, however, to your rights and interests therein; and I/we hereby authorize you to accept from the said Purchaser/Transferee the amount of $____, being the full balance due on my/our account, and upon receipt and acceptance of such amount you are instructed to surrender the Certificate of Title to said motor vehicle, properly released and endorsed within 10 days as required by law. |
| Signature of seller(s), and signature of dealer | Two signature rows with printed names and dates, subscribed under penalty of false statement as provided in Section 53a-157b. |
| THIS DOCUMENT IS NOT A CERTIFICATE OF TITLE | A band across the sheet in the biggest type on it, separating the seller's half from the dealer's. |
| Section 4, Signature of Dealer | Completed only by a Connecticut licensed dealer where the title cannot be obtained from the lienholder: an attestation under s. 14-180 that the original Connecticut certificate cannot be obtained and the lien has been satisfied, requesting the transfer be made on Assignment and Warranty of Title, previous Connecticut title only. |
There is no H-12 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.