How to fill out Connecticut SR-37

The sheet you sign when the lapse really did happen and you would rather pay than argue. Connecticut's civil penalty for failing to maintain mandatory security is $200, and this is the agreement that settles it: it waives the hearing, promises continuous coverage for the rest of the registration period, and - in a line most people miss - lets you cancel the plate at the same time if you are not keeping the car anyway.

Written against SR-37 (Rev 9-2014), issued under Conn. Gen. Stat. s. 14-12g(b), the consent agreement and the two-hundred-dollar civil penalty. Read the waiver before you sign rather than after. This agreement has the same force and effect as an order entered after a full hearing, and once executed there is no refund and no review - so if you genuinely held continuous cover, ring 860-263-5725 before the suspension date instead of posting this.

Two documents, and they are not the same thing. Take the blank SR-37 from the portal.ct.gov copy so you get the revision that is current today.

Step 1 · the form itself Blank SR-37 — Insurance Compliance Consent Agreement PDF at portal.ct.gov · new tab

Filled in

What a completed one looks like

This is the actual SR-37, rendered from the PDF the Connecticut Department of Motor Vehicles publishes and completed end to end: letterhead, every field, and the blocks at the foot.

Amber — you write it
Grey — not yours to fill
Numbered — explained below

A completed Connecticut Insurance Compliance Consent Agreement, form SR-37. The name is Theodore N. Bascomb with a mailing address at 31 Coe Avenue, Meriden, CT 06450, a case number and a telephone number. All three checklist boxes are ticked: the two hundred dollar cheque, the signed consent agreement and a copy of the current insurance card or return plate receipt. Below them the plate cancellation line carries the plate number AK52901 with the box ticked, and neither the Lost nor the Stolen box is marked. — Filled in by a seller settling one lapse and cancelling the plate in the same envelope. The Lost and Stolen ticks are greyed because the plate was neither. Every name and number here is invented for the sample.

Field by field

Every line, in the order you meet it

1
You fill this in
Name and Mailing Address
Copied off the warning notice, letter for letter, into the two boxes under the validation band.
Watch out: The band above these boxes is marked VALIDATED BY DMV ABOVE and is not yours - start at the name line.
2
You fill this in
Marker Plate Number or Case Number
Either one. The form accepts them interchangeably.
Watch out: Give the case number if you have the notice in front of you. Plate numbers get reissued; case numbers do not.
3
You fill this in
The three-item checklist
Tick each as you put it in the envelope: the $200 cheque or money order payable to DMV, the signed agreement, and a copy of your current insurance card or the return plate receipt.
Watch out: The third item is an either/or, and the plate receipt is the one that fits a seller. You are not being asked to insure a car you no longer own.
4
You fill this in
The plate cancellation line, and the signature below it
Print the plate number, tick the box, and indicate whether the plates were lost or stolen if they were. One signature and a date go on the two rules at the foot.
Watch out: That line is what turns a penalty payment into a closed file - leave it blank on a car you have sold and the registration is still running when the next renewal notice arrives. And read the waiver before signing: there is no cooling-off period written into this agreement.

At a glance

What goes where

On the form	What to put in it
Name, and Mailing Address	Yours, copied from the warning notice this agreement answers.
Marker Plate Number or Case Number	Either identifier is accepted, which is useful where the notice arrived after the plate was already cancelled.
Telephone Number	One box beside the plate or case number.
FEE PAYABLE - $200.00	Printed on the form as a fixed figure rather than calculated. It is the civil penalty in s. 14-12g(b).
A three-item checklist	$200.00 Check or Money Order payable to DMV. Signed Consent Agreement. Copy of your current Insurance Card or Return Plate Receipt.
To cancel the registration plate # ____ check this box and indicate if the plates were either Lost or Stolen	A plate number box, a tick, and two further ticks. This is the line that lets one sheet both settle the penalty and end the registration.
The waiver paragraph	The respondent, without the admission of wrongdoing of any nature, whether criminal or civil, or by commission or omission, does not desire to contest this matter and agrees to waive the right to seek administrative or judicial review of this Consent Agreement and its resulting order.
The force-and-effect paragraph	This Consent Agreement shall have the same force and effect as an order entered after a full hearing and shall be final when executed.
The stipulation	The respondent stipulates that (s)he will maintain continuous insurance coverage for the balance of the registration period. (S)he further understands that, in the event of any further violation, the Department may take any action authorized by law.
The paying-is-agreeing paragraph	By presenting the required evidence of mandatory security and paying such civil penalty (regardless of whether the respondent has signed this Consent Agreement), the respondent acknowledges that (s)he is waiving the opportunity to seek a refund of the civil penalty.
Signature Required, and Date Signed	Two lines at the foot. There is no witness and no notary.

What gets this one rejected

•Sending the agreement with no proof of insurance and no plate receipt. The checklist gives you the choice of either, but not of neither.
•A cheque for the wrong amount. The figure is printed on the form and it is $200 per lapse, not per notice.
•Signing it while intending to dispute the case. The waiver paragraph is unambiguous and the form is final when executed.
•Using it where you never had a lapse. If you had continuous coverage, the route is proof of it or a hearing, not a consent agreement and $200.
•Missing the plate cancellation line at the bottom. A seller who no longer has the car and does not tick it settles the penalty and leaves the registration running.

Rules that decide whether it is accepted

•Paying is agreeing, whether or not you sign. The form's own words: regardless of whether the respondent has signed this Consent Agreement. Sending the cheque is itself the waiver.
•The fourteen-day mercy. Section 14-12g(a) lets the commissioner decline to issue a suspension notice where the violation cannot be established for a period of more than fourteen days. A short gap between selling the car and cancelling the policy may never generate a notice at all.
•Thirty days, and then your licence. Section 14-12g(c): where a registration has been suspended and thirty days pass without a consent agreement, a cancellation of the registration or a transfer of ownership, the commissioner may suspend the owner's driver's licence.
•The department takes it three ways. Online through its compliance service, by telephone on 860-263-5725, or by post to the Insurance Compliance Unit with the signed agreement, the insurance card and the cheque.
•The penalty is per lapse. The compliance page's phrasing: an uninsured motorist civil penalty for each lapse of insurance of $200. Two gaps in one registration period are two penalties.

Every line here was read off SR-37 (Rev 9-2014) itself — the PDF is here — and off 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.

How to fill out Connecticut SR-37

What a completed one looks like

Every line, in the order you meet it

Name and Mailing Address

Marker Plate Number or Case Number

The three-item checklist

The plate cancellation line, and the signature below it

What goes where

What gets this one rejected

Rules that decide whether it is accepted

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