Form Dr 2539a - Duplicate Title Request And Receipt
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DR 2539A (03/02/10)
COLORADO DEPARTMENT OF REVENUE
Division of MotoR vehicles
title section
DUPLICATE TITLE REQUEST AND RECEIPT
C.R.S. 42-6-125, 42-6-126, 42-6-135, 42-6-137
REMIT $8.20 FOR DUPLICATE TITLE
NO REFUNDS wILL bE gRANTED FOR DUPLICATE TITLE REQUESTS
sections in bold text represent required information. If any bolded field is left blank, your application will be rejected.
THIS STATEMENT MUST bE SIgNED bY OwNER, AgENT OR LIENHOLDER
I certify, under penalty of perjury in the second degree, that the title for this vehicle will be issued to me as:
(Check One)
Owner
Agent
Lienholder
and the original title has been lost or destroyed, has not been assigned or transferred, and is subject only to lien(s) shown on State Motor Vehicle re-
cords. I understand that this duplicate title will be the only valid certificate of title and the original and any previously issued duplicate title(s) will be void.
Hand printed Name as it Appears on Identification of Owner, Agent, or Lienholder (include firm name if applicable)
Signature of Owner, Agent, or Lienholder
Date
Identification of individual signing above:*
Colorado DL
Colorado ID
Other ________________________________________________________________
ID #
Expires
DOb
The undersigned witness affirms that the named owner of the vehicle identified in this document presented the identification described above.
Witness Signature
Date
*Identification will be required for all duplicate title transactions. Secure and Verifiable Identification is required when the original title was issued on or after July 1, 2006.
Year of Vehicle
Make
Body Style
title no.
issue Date*
county of issue
Vehicle Identification Number
license Plate number
state of issue
(VIN)
Owner Name
STATE USE ONLY
REJECTION - YOUR APPLICATION HAS BEEN REJECTED
FOR ONE OF THE FOLLOwINg REASONS
Address
No record of this Vehicle Identification Number was found in
city
state
ZiP
Colorado records. Please submit a copy of your registration or
contact the county where your vehicle was first titled.
The title for your vehicle is held by the State of _______________.
LIENHOLDER
Colorado issued plates only for this vehicle. The title number was issued
name
for record keeping purposes only. Contact the state listed above.
Lien expired. Owner or Agent by Power of Attorney must apply.
Address
(See step 2 on page 2)
Identification/Secure and Verifiable ID of Owner, Agent by Power of
city
state
ZiP
Attorney/Lienholder Agent required. (See step 4 on page 2)
DR 2842, Supplemental Secure and Verifiable Identification
PLEASE PROVIDE MAILING ADDRESS BELOW. TO EXPEDITE,
Information and Attestation Clause - required from grantor.
PLEASE INCLUDE A SELF ADDRESSED STAMPED ENVELOPE.
(See step 2 page 2)
name
Lien NOT filed in Colorado. You must submit either a Power of
Attorney from the Owner (see step 5 on page 2) OR an Affidavit of
Address
Repossession AND certified copy of the finance agreement.
Lien release required. (See step 3 on page 2)
city
state
ZiP
POA (Power of Attorney) or LOA (Letter of Authorization) required.
(See step 6 on page 2)
• Make check or money order payable to:
Account number
COLORADO DEPARTMENT OF REVENUE, OR
M1525571
• If applying at your County Motor Vehicle, make check payable to:
COUNTY CLERk.
The state may convert your check to a one time electronic banking transaction. Your bank account
5750
may be debited as early as the same day received by the State. If converted, your check will not
TOTAL AMOUNT
(999)
$8.20
be returned. If your check is rejected due to insufficient or uncollected funds, the Department of
Revenue may collect the payment amount directly from your bank account electronically.
(Next Page)
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