P 246 Form – Fill Out and Use This PDF

The P 246 form is a tax return used by employers to report income and withholdings from an employee's paycheck.

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P 246 Form PDF Details

P 246 Form is a document that you will use to declare your organization's exempt status with the Internal Revenue Service (IRS). This form must be filed annually in order to maintain your exemption. There are specific instructions for completing this form, and it is important to ensure that all information is accurate and up-to-date. Completing this form correctly is critical, as improper filing can lead to loss of tax-exempt status. For more information on P 246 Form, please consult the IRS website.

This information will allow you to comprehend better the details of the p 246 form before you start filling it out.

Question	Answer
Form Name	P 246 Form
Form Length	1 pages
Fillable?	Yes
Fillable fields	26
Avg. time to fill out	5 min 27 sec
Other names	ct p246, ct interlock application, p246, p 246

12

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IGNITION INTERLOCK DEVICE

INSTALLATION APPLICATION

P-246 Rev. 7-2016

STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

DRIVER SERVICES DIVISION

60 State Street, Wethersfield, CT 06161-2525

TELEPHONE: (860) 263-5720

INSTRUCTIONS (Please print or type):

1.Complete Part 1 of this form and sign the Operator Certification. If you are not the owner of record for the vehicle listed, the registered owner must complete and sign Part 2.

2.Contact one of the Connecticut approved vendors to schedule an appointment to install the Ignition Interlock Device (IID). The installer must complete and sign Part 3. Submit the completed form to the address above.

3.The vehicle listed on this form must have a valid registration. If the vehicle is registered outside Connecticut, you must submit a copy of the registration certificate.

4.Pay the $175.00 restoration fee and the $100.00 IID Administration fee. You may pay the fees online at ct.gov/dmv or by a check or money order made payable to DMV and mailed to the above address.

5.Vendor information and additional forms can be found at ct.gov/dmv

6.Your IID requirement starts from the date of restoration not installation.

PART 1 - OPERATOR/VEHICLE INFORMATION

APPLICANT'S NAME (As it appears on your operator's license)

(Last)

(First)

(Middle)

DATE OF BIRTH

LICENSING STATE

OPERATOR LICENSE NUMBER

(AREA CODE) HOME TELEPHONE NUMBER

MAILING ADDRESS

(Number and Street)

(City or Town)

(State)

(Zip Code)

VEHICLE IDENTIFICATION NUMBER (VIN)

YEAR

MAKE

REG. PLATE #

STATE

OPERATOR CERTIFICATION

Following approval by the Department of Motor Vehicles, I understand that I must have an Ignition Interlock Device (IID) in each vehicle that I own or operate during the entire time that I am subject to an IID restriction, and that such device must be maintained and calibrated in accordance with DMV regulations.

The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of false statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.

SIGNATURE

DATE SIGNED

X

PART 2 - OWNER INFORMATION/AUTHORIZATION

VEHICLE OWNER

ADDRESS

CITY

STATE

ZIP CODE

I swear or affirm under penalty of false statement in accordance with Connecticut General Statutes §14-110 and §53a-157, and subject to penalties for perjury for a deliberate false statement, that the above information and any attachment is true and correct.

PRINTED NAME OF OWNER		SIGNATURE OF OWNER	DATE SIGNED
		X
	PART 3 - INSTALLER

IID TYPE

IID MODEL

IID SERIAL #

IID VENDOR

INSTALLED AT (Printed Business Name and Address):

The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of false statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.

SIGNATURE OF INSTALLER

X

DATE SIGNED

PRINTED NAME OF INSTALLER ( Last, First, Middle)

DO NOT OPERATE A MOTOR VEHICLE UNTIL YOU RECEIVE CONFIRMATION

THAT YOU ARE RESTORED AND HAVE A VALID LICENSE.

ALLOW 10 BUSINESS DAYS FOR PROCESSING

How to Edit P 246 Form Online for Free

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ct interlock application empty spaces to fill out

Jot down the details in the PRINTED, NAME, OF, OWNER II, D, TYPE II, D, MODEL SIGNATURE, OF, OWNER, X PART, INSTALLER, II, D, SERIAL II, D, VENDOR DATE, SIGNED SIGNATURE, OF, INSTALLER, X DATE, SIGNED and ALLOW, BUSINESS, DAYS, FOR, PROCESSING field.

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