Nonresidence And Military Service Exemption From Specific Ownership Tax Affidavit Form
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2DR 2667 (06/29/11)
COLORADO DEPARTMENT OF REVENUE
DIVISION OF MOTOR VEHICLES
REGISTRATION SECTION
NONRESIDENCE AND MILITARY
SERVICE EXEMPTION FROM SPECIFIC
OWNERSHIP TAX AFFIDAVIT
Incomplete application will not be processed.
C.R.S. 42-3-104(9)
APPLICANT - This form is to be completed when the vehicle owner(s) meet the exemption requirements as listed in C.R.S.
42-3-104(9) and /or the Servicemembers Civil Relief Act and the Military Spouse Residency Relief Act contained in sections
1, 2, and 3, Title 50 App. U.S.C. Only the military individual, servicemember’s spouse, or a lawful agent with power of attorney
(POA) may execute this affidavit. Registration must be completed within 60 days of affidavit execution.
Servicemember’s Name or Servicemember’s Spouse’s Name
Social Security Number
Colorado Address (Street Address, City and ZIP)
County
Colorado Military Installation Servicemember is Assigned to Under Orders
Duty Telephone Number
(
)
Vehicle Identification Number (VIN)
Year
Make
Body
State Where Vehicle Purchased
Date of Purchase
State of Legal Residence
I, being first duly sworn, claim exemption from the Colorado Specific Ownership Tax on the vehicle listed above
under C.R.S. 42-3-104(9), the Servicemembers Civil Relief Act, and the Military Spouse Residency Relief Act. I am
registering this vehicle in Colorado and claiming exemption from the Specific Ownership Tax because the vehicle is
located in Colorado as a result of military service. To support my claim, I further acknowledge that:
•
I am not a legal resident of the State of Colorado.
•
I am a member of the Armed Forces of the United States, serving under orders in Colorado or I am the spouse of
a Servicemember serving under order in Colorado.
•
I am a named owner on the vehicle for which the exemption is being claimed.
•
This vehicle will not be used in any trade or business in the State of Colorado. Should this vehicle be used as part
of a business, the vehicle will be subject to full payment of all taxes due.
Execution of this claim for exemption of specific ownership tax may be completed by:
•
Servicemember - Military ID is required to be presented with this form, copy of orders (issued in the
servicemembers name), and a current leave and earnings statement are required to be attached to this form.
•
Servicemember’s Spouse or Agent - Copy of orders, leave and earnings statement, and Power of Attorney is
required to be attached to this form. Servicemember’s spouse’s military ID must list the servicemember as the
sponsor.
I certify, under penalty of perjury, that the above statements are true and accurate to the best of my knowledge. The
Department reserves the right to validate the above statements with the military installation and/or servicemembers
commanding officer.
Printed name as it appears on identification of applicant.
Signature
Date
Secure and Verifiable ID of Owner/Agent:
Colorado DL
Colorado ID
Other _____________________________________
ID #
Expires
DOB
The undersigned witness affirms that the Identification described above was presented to me.
Witness Printed Name
Witness Signature
NOTE: Certification must be completed on reverse side.
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