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Free Colorado Out of State Residency Affidavit Form - PDF Form Download

Colorado Out of State Residency Affidavit Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews
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Use this template/form as an Out of State Residency Affidavit in the State of Colorado


colorado-out-of-state-residency-affidavit-form

Text version of this Form

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DR 2680 (09/05/06)

COLORADO DEPARTMENT OF REVENUE

DIVISION OF MOTOR VEHICLES

DRIVER CONTROL SECTION

VOICE (303) 205-5613

FAX (303) 205-8430

OUT OF STATE RESIDENCY AFFIDAVIT

(§ 42-7-408, C.R.S.)

DRIVER SECTION: to be completed by a driver under a Colorado SR22 requirement, in the presence of a Notary Public

I, ____________________________________, do hereby attest to the following facts concerning my State of residency.

(please print full name)

1. On _____/______/_____ I became a resident of the State of ____________________________________________.

Current Address Date of Birth

City State ZIP Code

2. I applied for a driver’s license in the above state on _____/______/_____ .

I swear and attest that the aforementioned statements are true and correct, under the penalties of perjury. If I return to the

State of Colorado prior to the expiration date of the SR22 requirement period, I understand that I will be required to provide

an SR22 for the balance of the period of requirement.

Signature of Driver (affidavit) Date

NOTARY PUBLIC SECTION:

Subscribed and sworn before me this ___________________________ day of __________________________, 20_____.

My commission expires Seal

Signature of Notary Public

DRIVER’S LICENSING OFFICIAL: to be completed by an official of the driver’s licensing authority in the

state of residence.

The above named person has either obtained/applied or attempted to apply for a driver’s license in this state. If cleared by

the State of Colorado, the driver is eligible for driving privileges in this state.

State Date

Licensing Official’s Name Title

Licensing Official’s Signature Phone

( )

Mailing Address

City State ZIP Code

IN ORDER FOR OUR DEPARTMENT TO ACCEPT THIS FORM,

ALL 3 SECTIONS MUST BE COMPLETED IN FULL.

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