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