How to fill out Connecticut Statement of Non-Receipt
For the title that was applied for and never arrived. Connecticut posts certificates about thirty days after registration, and where one does not turn up there is a ninety-day window in which the department will issue another at no cost. This is the form that opens it. It is not a replacement application and it carries no fee at all - it is a sworn statement that the original never reached you and that you have not put a loan on the car since applying.
Written against Statement of Non-Receipt (no revision printed), issued under Conn. Gen. Stat. s. 14-175 and s. 14-178, administered by the DMV Title Unit at Room 305.
The department prints no revision date on this form at all, so there is no way to tell an old copy from a current one. Take it from the department's own link at the time you need it, and check the Room 305 address on the current title services page before posting.
Two documents, and they are not the same thing. Take the blank Statement of Non-Receipt from the portal.ct.gov copy so you get the revision that is current today.
This is the actual Statement of Non-Receipt, 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
Filled in inside the ninety-day window, which is what makes it free. Rendered from the department's own PDF - a flat sheet with ruled lines rather than fillable boxes, so the rectangles here were read off the rules the department drew. Every name and number is invented for the sample.
Field by field
Every line, in the order you meet it
1
You fill this in
Name and Certificate of Title No.
Your name as it went on the application, and the title number if you have it.
Watch out: The number is printed on the registration certificate. Connecticut notes on the face of each registration that a certificate of title has been issued for the vehicle.
2
You fill this in
Address
Where the certificate should have gone.
Watch out: If it is not the address the department holds, that is very likely the reason nothing arrived - fix the address record first, or the replacement goes the same way.
3
You fill this in
The certification line: your name and the application date
I ____ hereby certify that on ____ I applied for a certificate of title to a motor vehicle.
Watch out: The date is the application date, not today. It is the date the ninety-day window runs from.
4
You fill this in
DMV office
Where the application was made.
Watch out: Put the branch name if you went in person. Where a dealer registered the car for you, that is worth saying here rather than leaving blank.
5
You fill this in
Year, Make and Identification number
A year box, a make box and the identification number, and nothing else about the car is asked for.
Watch out: The VIN is what the department searches on, and it is the only one of the three that has to be exact.
6
You fill this in
Owner's Signature and Date Signed
One signature, under a certification covering both limbs - non-receipt and no new encumbrance.
Watch out: The second limb is the one people sign without reading. If you have financed the car since applying, this form is not the right one.
At a glance
What goes where
On the form
What to put in it
Name, and Certificate of Title No.
Two boxes on the first line. The title number comes from the registration certificate, which notes on its face that a title has been issued.
Address
One full-width line beneath.
I ____ hereby certify that on ____
Your name and the date you applied for the certificate.
at ____ (DMV office)
Which office the application was made at, or by post.
____ (Year) ____ (Make), Identification number ____
Two short blanks and a long one, sitting in the middle of the certifying sentence rather than in a table.
and, that as of this date I have not received the Certificate of Title
The first limb of the statement - the fact the whole form exists to record.
The encumbrance limb
I further certify that from the date of the application for a Certificate of Title, until the date of this statement, I have not encumbered the within described motor vehicle by note, loan, chattel mortgage, or any other type or security pledge. Therefore, application is hereby made for a replacement of the original of said title.
The certification
Subscribed under penalty of false statement in accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes.
(Owner's Signature), and (Date Signed)
Two lines at the foot, with no notary block and no witness line.
What gets this one rejected
•Filing it more than ninety days after the transaction. The department's window is ninety days from the transaction date to re-apply at no cost; past that it is a paid H-6B.
•Filing it before thirty days have passed. The usual processing time for the issuance of a Connecticut title is thirty days from the date the vehicle is registered, so a statement at day ten is premature.
•Signing the encumbrance limb where a loan has been taken out since. That sentence is the substance of the form and it is sworn.
•Sending it to the wrong room. It goes to Department of Motor Vehicles, Room 305, Specialized Registry Services, 60 State Street, Wethersfield, CT 06161 - printed on the department's own page.
•Using it as a seller when the title was never in your name. It is the applicant's statement about their own application, not a general lost-title form.
Rules that decide whether it is accepted
•No fee, if you are inside the window. The department verifies eligibility and issues at no cost. It is the only route to a Connecticut certificate that carries no fee.
•Two different processing estimates are published. The title services page says the process will take about thirty days; the sell-without-a-title page says up to fourteen. Both were read on 23 August 2026 and neither is a promise.
•Where the title went, if there was a lien. It did not go astray - it went to the lender. If there is a lien on the title, the title is mailed to the lienholder, and no statement of non-receipt is needed.
•It is not the same as a replacement application. An H-6B produces a certificate carrying a permanent legend about the rights of a person under the original. A no-fee re-issue inside the ninety days does not put you in that position.
Every line here was read off Statement of Non-Receipt (no revision printed) 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.
