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? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | p 249 form, ct dmv p 249, p246 form, ct 246 |
IGNITION INTERLOCK DEVICE
INSTALLATION APPLICATION
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DRIVER SERVICES DIVISION
60 State Street, Wethersfield, CT
TELEPHONE: (860)
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
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
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
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