Form Dr 2680 - Out Of State Residency Affidavit

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