INSTRUCTIONS: COMPLAINT AGAINST CT LICENSED DEALER OR REPAIRER (Form K-35)

To file a complaint against a Connecticut licensed dealer or repairer, use a form K-35. This document can be obtained from the website of the government of the state of Connecticut.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 1: The first section concerns the the repair shop or dealership. Enter the business name as it appears on your invoice in the first blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 2: Enter the dates during which your vehicle was in the custody of the business in the second blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 3: Enter the business street address, city or town, state and zip code in the next two blank boxes.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 4: Enter the dealer or repairer phone number in the next blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 5: Enter the name of the person you dealt with in the next blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 6: The next person concerns the complainant. Enter your name in the first blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 7: Enter the date of service or sale in the next blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 8: Enter your street address, city or town, state and zip code in the next blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 9: Enter your phone number between the hours of 8 a.m. to 4 p.m., Monday through Friday, in the next blank box.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 10: The next section concerns your vehicle. In the first four blank boxes of this section, enter its make, model, year and marker plate number.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 11: In the next three blank boxes, enter the vehicle identification number, current odometer reading and odometer reading at the time of repair or sale.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 12: Indicate the nature of your complaint with a check mark.

Complaint Against CT Licensed Dealer Or Repairer K-35 Step 13: Provide a written explanation of your complaint. Sign and date the bottom of the page.

INSTRUCTIONS: CONNECTICUT RESPIRATORY DISEASES (Form P-142R)

When a Connecticut driver is referred to the state Department of Motor Vehicles over concerns regarding their ability to operate a motor vehicle safely due to a respiratory disease, a form P-142R is used to submit the evaluation of a medical professional. This document can be obtained from the website of the government of Connecticut.

Connecticut Respiratory Diseases P-142R Step 1: The patient will enter their signature in the first blank box and the date in the second blank box to authorize the release of the medical report in question and related materials to the Department of Motor Vehicles. The remainder of the form should be completed by the medical professional.

Connecticut Respiratory Diseases P-142R Step 2: Enter the patient's name in the third blank box.

Connecticut Respiratory Diseases P-142R Step 3: Enter the patient's date of birth in the fourth blank box.

Connecticut Respiratory Diseases P-142R Step 4: Enter the patient's telephone number in the fifth blank box.

Connecticut Respiratory Diseases P-142R Step 5: Enter the patient's full address in the sixth blank box.

Connecticut Respiratory Diseases P-142R Step 6: Enter the date of the patient's last examination and how long you have been treating them in the seventh blank box.

Connecticut Respiratory Diseases P-142R Step 7: Indicate with a check mark whether the patient has asthma, sleep apnea, chronic obstructive pulmonary disease or other. If the latter, provide an explanation.

Connecticut Respiratory Diseases P-142R Step 8: Indicate whether this is a progressive illness with a check mark. If yes, comment on the progress of the illness.

Connecticut Respiratory Diseases P-142R Step 9: Indicate whether special aids or devices must be utilized while the patient is operating a motor vehicle with a check mark. If yes, specify.

Connecticut Respiratory Diseases P-142R Step 10: Indicate with a check mark whether the patient is capable of exhaling 1000cc of air in one continuous breath during operation of an ignition interlock device. If no, provide an explanation.

Connecticut Respiratory Diseases P-142R Step 11: Indicate with a check mark whether you believe the patient understands the risk posed by their condition that may affect safe motor vehicle operation.

Connecticut Respiratory Diseases P-142R Step 12: Answer all remaining questions as instructed and provide all required identifying information at the bottom of the form.

INSTRUCTIONS: CONNECTICUT LICENSE INSPECTION APPLICATION (Form K-8)

To apply for a new Connecticut license to act as a new or used vehicle dealer or a general or limited vehicle repairer, use a form K-8. This document can be obtained from the website of the government of Connecticut.

Connecticut License Inspection Application K-8 Step 1: Section 1 concerns the business and its management. In the first two blank boxes, enter the business name  and federal employer identification number.

Connecticut License Inspection Application K-8 Step 2: In the next blank box, enter the business "doing business as" name.

Connecticut License Inspection Application K-8 Step 3: In the next two blank boxes, enter the complete business address and, if different, the mailing address.

Connecticut License Inspection Application K-8 Step 4: In the next three blank boxes, enter the name of a manager, operator or contact person, a business telephone number and a business email address.

Connecticut License Inspection Application K-8 Step 5: In the next two blank boxes, enter the business Department of Revenue Services sales tax identification number and the name and license number of the company contracted to remove hazardous waste.

Connecticut License Inspection Application K-8 Step 6: In the next two blank boxes, enter all other licenses held and (if a new car dealer) list all franchises.

Connecticut License Inspection Application K-8 Step 7: Section 2 begins on the first page with section 2A and continues through page 6. Provide all requested information concerning business personnel.

Connecticut License Inspection Application K-8 Step 8: Section 3 on the seventh page concerns the business site.

Connecticut License Inspection Application K-8 Step 9: Section 4 on the seventh page concerns the business office.

Connecticut License Inspection Application K-8 Step 10: Section 5 on the eighth page concerns repair services offered.

Connecticut License Inspection Application K-8 Step 11: Section 6 on the ninth page is a questionnaire concerning various other aspects of your business.

Connecticut License Inspection Application K-8 Step 12: Section 7 requires the qualified person completing the form to provide their printed name, position with the business, driver's license number and signature. This must be done in the presence of a notary or inspector, who will enter the place of signing, the date, their signature and their printed name. Inspectors may enter any comments they have at the bottom of the page.

INSTRUCTIONS: CONNECTICUT RECEIVED JUNK VEHICLES REPORT (Form K-174)

Connecticut motor vehicle dealers and repairers with a recycler's license are required to submit a form K-174 to document junk vehicles they have received twice a month. This document can be obtained from the website of the government of the state of Connecticut.

Connecticut Received Junk Vehicles Report K-174 Step 1: Indicate with a check mark whether filing to document the period from the 1st to the 15th of the month or for the period from the 16th to the last day of the month.

Connecticut Received Junk Vehicles Report K-174 Step 2: Enter the month and year for which you are filing.

Connecticut Received Junk Vehicles Report K-174 Step 3: Where indicated, write your business name as it appears on your recycler's license.

Connecticut Received Junk Vehicles Report K-174 Step 4: Enter your business address where indicated.

Connecticut Received Junk Vehicles Report K-174 Step 5: Check the box where indicated if no vehicles were received during this reporting period.

Connecticut Received Junk Vehicles Report K-174 Step 6: Enter your license number where indicated.

Connecticut Received Junk Vehicles Report K-174 Step 7: Enter your telephone number where indicated.

Connecticut Received Junk Vehicles Report K-174 Step 8: The table provided below is for documentation of all received junk vehicles. In the first column, enter the make of each vehicle.

Connecticut Received Junk Vehicles Report K-174 Step 9: In the second column, enter the year of each vehicle.

Connecticut Received Junk Vehicles Report K-174 Step 10: In the third column, enter the engine number, if any, of each vehicle.

Connecticut Received Junk Vehicles Report K-174 Step 11: In the fourth column, enter the vehicle identification number of each vehicle.

Connecticut Received Junk Vehicles Report K-174 Step 12: In the fifth column, enter the ownership document of each vehicle.

Connecticut Received Junk Vehicles Report K-174 Step 13: In the sixth column, enter the state in which each vehicle has been registered.

Connecticut Received Junk Vehicles Report K-174 Step 14: In the first blank box at the bottom of the page, the service manager or their designee should provide their signature.

Connecticut Received Junk Vehicles Report K-174 Step 15: In the second blank box, enter the title of the authorized official signing this form.

Connecticut Received Junk Vehicles Report K-174 Step 16: Enter the date in the third blank box.

INSTRUCTIONS: ALABAMA OFFICE-BASED SURGERY / PROCEDURES PHYSICIAN REGISTRATION FORM

The form discussed in this article is used by Alabama physicians to document their office-based surgery procedures. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 1: Enter your name on the first blank line.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 2: Enter your Alabama license number on the second blank line.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 3: Enter your street address, city, state and zip code on the third blank line.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 4: Indicate with a check mark whether your office performs procedures using moderate sedation analgesia, in which patients are placed into a drug-induced depression of consciousness during which they respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 5: Indicate with a check mark whether your office performs procedures using deep sedation analgesia, in which patients are placed into a drug-induced depression of consciousness during which they cannot be easily aroused but can respond purposefully following repeated or painful stimulation.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 6: Indicate with a check mark whether your office performs procedures using general anesthesia, in which patients are placed into a drug-induced loss of consciousness during which they are not arousable, even by painful stimulation.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 7: Indicate with a check mark whether you as a physician meet the training requirements set forth in the Alabama Board of Medical Examiners' Office-Based Surgery Rules for moderate sedation, deep sedation and general anesthesia.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 8: Indicate with a check mark whether your office is currently accredited by the Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities, or the Joint Commission on Accreditation of Healthcare Organizations. Indicate which organization, if applicable, with a check mark.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 9: If not currently accredited, indicate with a check mark whether you plan on obtaining accreditation in the next two years.

Alabama Office-Based Surgery / Procedures Physician Registration Form Step 10: Sign and date the bottom of the form, as well as entering your Alabama medical license number.