Form Dr 2559 - Permission For Release Of Individual Records - Colorado Department Of Revenue

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DR 2559 (02/10/17)
Search Fee $9.00
COLORADO DEPARTMENT OF REVENUE
Certified fee (additional) $1.00
Division Of Motor Vehicles
Driver Control Section, Room 164
PO Box 173345
Denver, CO 80217-3345
Permission to Release Driver Records
to Self or Another Person
Driver’s License offices provide only personal driving record information.
Records and/or other requests are available only at 1881 Pierce St., Lakewood, CO
Pursuant to §42-1-206(1)(b)(II) (7)(a) and (7)(b)(XIII), C.R.S.
I (Please Print Last Name)
First Name
hereby authorize the release of personal information contained in records maintained by the Colorado Department
of Revenue, Division of Motor Vehicles, to:
Last Name
First Name
Check if to self
Pursuant to the Driver’s Privacy Protection Act (18 USC 2721) and Colorado law (§24-72-204, §42-1-206 (1)(b)(l)).
Driver
Driver’s Date of Birth
Driver’s License Number
Signature
Date
Signature of Parent or Guardian if Driver is a Minor
Date
Person Receiving Record
Release Records to: Last Name
First Name
Driver’s License Number
State
Company (if applicable)
Mailing Address
City
State
Zip Code
If your check is returned for insufficient funds or a closed account, you may not be issued or renew any type of driver’s
license or identification card until the original check is redeemed and an administrative and short check fee are paid.
Under penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited
by law. I understand that motor vehicle or driver records that are obtained, resold, or transferred for purposes prohibited
by law may subject me to civil penalties under federal and state law. All of the information provided is true and accurate
to the best of my knowledge.
Signature of Requestor
Date

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