INSTRUCTIONS: CONNECTICUT EXAMINATION TO DETERMINE PHYSICAL CONDITION OF DRIVER (Form R-323)

In order to receive a license to operate as a commercial vehicle operator in Connecticut, you must be certified as in shape to do so. This examination is documented using a form R-323, which can be obtained from the website of the government of Connecticut.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 1: The first section concerns the driver and should be completed by them. In the first three blank boxes, enter your name, Social Security number and birthdate.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 2: Indicate your sex with a check mark in the fourth blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 3: Indicate whether you are applying for a new certification, a recertification or a follow-up with a check mark in the fifth blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 4: Enter the date of the exam in the sixth blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 5: Enter your street address, city or town, state and zip code in the seventh blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 6: Enter your work telephone number in the eighth blank box and your home telephone number in the ninth blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 7: Enter your driver's license number in the tenth blank box. Indicate your license cass with a check mark in the eleventh blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 8: Enter the state that issued your driver's license in the twelfth blank box.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 9: Section 2 documents the driver's health history. For each condition, indicate whether it is in your history by checking "Yes" or "No" as applicable. For all conditions to which you answered "Yes," provide the onset date, diagnosis, the treating physician's name and address, any current limitations and all medications used recently or currently.

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 10: Sections 3 through 7 will be completed by the medical examiner, who will sign and date the bottom of the second page.

INSTRUCTIONS: CONNECTICUT MUNICIPALITY REPORT OF ABANDONED MOTOR VEHICLE (Form H-109)

When a Connecticut municipality takes possession of an abandoned motor vehicle whose value is $50,000 or less, which is unusable and which does not have a valid marker plate, this is documented using a form H-109. This document can be obtained from the website of the government of the state of Connecticut.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 1: Section A should be completed when possession of the motor vehicle is taken by the municipality. Enter the name of the municipality in the first blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 2: Enter the date and time the vehicle was taken into custody in the second blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 3: Enter the name of the officer or inspector who evaluated the vehicle in the third blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 4: Enter the badge number of the officer or inspector in the fourth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 5: Enter the year of the vehicle in the fifth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 6: Enter the make of the vehicle in the sixth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 7: Enter the vehicle identification number in the seventh blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 8: Enter the location where the abandoned vehicle was found in the eighth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 9: Enter the business name and address of the tower in the ninth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 10: Enter the amount charged by the tower in the tenth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 11: Enter the department name in the eleventh blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 12: The authorized municipal official should enter their signature in the twelfth blank box and the date in the thirteenth blank box.

Connecticut Municipality Report Of Abandoned Motor Vehicle H-109 Step 13: Section B should be completed when the vehicle has had its ownership transferred to a junkyard.

INSTRUCTIONS: CONNECTICUT APPLICATION FOR WITHHOLDING OF RESIDENT ADDRESS (Form E-224)

Connecticut residents who work in an official capacity for the state use a form E-224 to request that their residential address be withheld from a motor vehicle or vessel license. This document can be obtained from the website of the government of Connecticut.

Connecticut Application For Withholding Of Resident Address E-224 Step 1: Indicate with a check mark whether this application is new, documents a change or if you no longer qualify for withholding of your residential address.

Connecticut Application For Withholding Of Resident Address E-224 Step 2: If this is an application documenting, enter the nature of the change.

Connecticut Application For Withholding Of Resident Address E-224 Step 3: The next section concerns the applicant. Enter the name of your business organization or department in the first blank box.

Connecticut Application For Withholding Of Resident Address E-224 Step 4: Enter your date of birth and business email address in the next two blank boxes.

Connecticut Application For Withholding Of Resident Address E-224 Step 5: Enter the name of the applicant in the next blank box.

Connecticut Application For Withholding Of Resident Address E-224 Step 6: Enter your business telephone number in the next blank box.

Connecticut Application For Withholding Of Resident Address E-224 Step 7: Enter your complete business address in the next two blank boxes.

Connecticut Application For Withholding Of Resident Address E-224 Step 8: Enter your official title and home phone number in the next two blank boxes.

Connecticut Application For Withholding Of Resident Address E-224 Step 9: Enter your residential address in the next blank box.

Connecticut Application For Withholding Of Resident Address E-224 Step 10: Indicate your official status with a check mark.

Connecticut Application For Withholding Of Resident Address E-224 Step 11: The next section should be completed by your supervisor, who should enter their name, title, signature, the date and their phone number.

Connecticut Application For Withholding Of Resident Address E-224 Step 12: In the next section, enter all applicable vehicle registration plate numbers and registration classes. If applicable, also enter your vessel registration number.

Connecticut Application For Withholding Of Resident Address E-224 Step 13: At the bottom of the form, enter your signature, operator license number, employee or badge number and the date.

INSTRUCTIONS: CONNECTICUT NEUROLOGY MEDICAL REPORT (Form P-142N)

When a Connecticut driver has been involved in an incident that may be related to a neurological condition, they may be required to be examined by a medical professional. This examination is documented using a form P-142N. This document can be obtained from the website of the government of Connecticut.

Connecticut Neurology Medical Report P-142N Step 1: Write the date of the incident being addressed.

Connecticut Neurology Medical Report P-142N Step 2: The patient should sign and date the first two blank boxes, then submit the form to the medical professional evaluating them for completion.

Connecticut Neurology Medical Report P-142N Step 3: Enter the patient's name, date of birth and telephone number in the first three blank boxes.

Connecticut Neurology Medical Report P-142N Step 4: Enter the patient's street address, city, state and zip code in the next blank box.

Connecticut Neurology Medical Report P-142N Step 5: In the next two blank boxes, enter how long you have been treating this patient and the date of their last examination.

Connecticut Neurology Medical Report P-142N Step 6: In the next blank section, enter how many years the patient has had this condition, as well as providing a brief diagnosis, etiology and prognosis.

Connecticut Neurology Medical Report P-142N Step 7: In the next blank section, write whether the patient has any other conditions which should be evaluated by another specialist. If so, provide an explanation.

Connecticut Neurology Medical Report P-142N Step 8: In the table provided below, document episodes of altered consciousness in the last two years. Enter the date and type of each episode.

Connecticut Neurology Medical Report P-142N Step 9: In the table provided below this, document medications relevant to motor vehicle operation as instructed.

Connecticut Neurology Medical Report P-142N Step 10: Indicate whether the condition warrants periodic reporting with a check mark. If so, write the condition and the frequency with which periodic status reports should be issued in months, as well as the duration of years for which these reports should continue.

Connecticut Neurology Medical Report P-142N Step 11: Answer all remaining questions by checking "yes" or "no" as applicable.

Connecticut Neurology Medical Report P-142N Step 12: Print and sign your name at the bottom of the page, as well as providing all other identifying information requested.