Fillable Form Dr 2567 - Promissory Note Contract printable pdf download

DR 2567 (07/25/06)

COLORADO DEPARTMENT OF REVENUE

DIVISION OF MOTOR VEHICLES

DRIVER CONTROL SECTION ROOM 164

(303) 205-5613

PROMISSORY NOTE CONTRACT

This is a legal document and you may wish to consult with an attorney before signing

1. This contract is entered into on this __________________ day of ___________________ 20 _______ between

Plaintiff/ Creditor (or Agent)

Address

Date of Birth

Driver's License Number

and

Defendant/Obligor

Address

Date of Birth

Driver's License Number

This contract is in accordance with §42-7-301, C.R.S. The term "State" refers to the State of Colorado, Depart-

ment of Revenue, Division of Motor Vehicles, Driver Control Section. The term "Director" refers to the Executive

Director of the Department of Revenue.

2. On _______________ (Date), ________________________________________________________ (Plaintiff (s))

was operating his/her vehicle in the State of Colorado and vehicle was involved in an accident with

__________________________________________________________________________________ (Defendant (s)).

The facts were as follows:

_______________________________________________________________________________________________

3. The Plaintiff (s) vehicle described as a______(year)____________(model) suffered damages of $____________.

The damages to Plaintiff(s) vehicle are described as follows: ______________________________________________________________________

______________________________________________________________________________________________

In addition as a result of the accident Plaintiff (s) has incurred additional expenses of $ ___________ .

Total Damages $ __________________ .

4. To meet the security required under §42-7-301, C.R.S., for the damages to the Plaintiff (s) vehicle described

above, the Defendant (s) enters into this contract with the Plaintiff (s) as follows:

• This amount may be determined by agreement of the parties, or by averaging three (3) estimates, or by other

methods acceptable to the parties.

a.The Defendant (s) agrees to pay to the order of the Plaintiff (s) the amount of $_______________ in United States

Dollars in full satisfaction of the damages listed in paragraph number 3 above. The terms, including due date of

payments, and length of the payments shall be:

$_____________ per month, on or before the ___________ day of each month for a total of ___________ months.

b.It is agreed that if any payment is not paid when due, the unpaid amount as set forth in paragraph 4 (a) shall be

deemed in default.

c. If the Defendant (s) defaults on the payment (s) as provided in paragraph (a) and (b) above, the Plaintiff (s) shall send

the Defendant (s) notice of default by certified mail.

Form Dr 2567 - Promissory Note Contract