Fillable Form Dr 2395 - Title And/or Registration Application printable pdf download

DR 2395 (02/22/11)

COLORADO DEPARTMENT OF REVENUE

DIVISION OF MOTOR VEHICLES

TITLE SECTION

TITLE and/or REGISTRATION APPLICATION

42-3-105, 42-6-107, 42-6-116, 42-6-117, C.R.S.

ANY ALTERATION OR ERASURE IN THIS AREA MAY VOID THIS DOCUMENT

Fuel Type

Vehicle Identification Number (VIN)

test information

Year

Make

Body

Model

Color

CWT

Dealer #

Date Purchased

Commercial Use

MSRP

Size (W x L)

Bus Cap.

Yes

Adult

Juvenile

LEGAL NAME(S) AS IT APPEARS ON IDENTIFICATION*

Lease

LEGAL NAME(S) AS IT APPEARS ON IDENTIFICATION

AND ADDRESS OF OWNER(S) OR ENTITY

Buy-Out

AND PHYSICAL ADDRESS OF LESSEE

Yes

INDICATE ALTERNATE ADDRESS HERE IF REGISTRATION RENEWAL IS TO BE SENT TO A

DIFFERENT ADDRESS

DR 2421 Attached

FIRST LIENHOLDER NAME AND ADDRESS

SECOND LIENHOLDER NAME AND ADDRESS**

Lien Amount

INDICATE ALTERNATE ADDRESS HERE IF THE TITLE SHOULD BE SENT TO A DIFFERENT LIENHOLDER ADDRESS

*DR 2421 Statement of One in the Same is required when the owner’s name on the Secure and Verifiable ID differs from the owner’s name on the application/title.

**If more than two lienholders, please attach separate documentation.

Motor vehicle insurance or operator's coverage is compulsory in the State of Colorado. Proof of insurance is required prior to issuance of a registration. Non-com-

pliance with this requirement is a misdemeanor traffic offense. Per C.R.S. 42-3-105(2), the minimum penalty is a five hundred dollar fine. The maximum penalty for

such offense is one year's imprisonment and a one-thousand-dollar fine. After obtaining a registration, you will be required to sign an affirmation clause indicating

compliance with insurance requirements.

Unless a person waives his or her confidentiality, the information contained in the person’s motor vehicle record shall not be used for any purpose other than a

purpose authorized by law, pursuant to C.R.S. 42-2-121 (4)(a).

I certify, under penalty of perjury in the second degree, that the above information is true and accurate to the best of my knowledge.

Owner or Agent Signature

Date

Printed name of Owner/Agent as it appears on Identification:

Secure and Verifiable ID of Owner/Agent:

Colorado DL

Colorado ID

Other _____________________________________________________________

ID#

Expires

DOB