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
No
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
No
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
Lien Amount
INDICATE ALTERNATE ADDRESS HERE IF THE TITLE SHOULD BE SENT TO A DIFFERENT LIENHOLDER ADDRESS
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
The undersigned witness affirms that the named owner of the vehicle identified in this document presented the identification described above.
Witness Signature
Date
COUNTY USE ONLY (Dealers/Lienholders: Do Not Write Below this Line)
PREVIOUS TITLE NUMBER
TITLE NUMBER
Date Accepted
Purchase Price
Odometer Reading & Indicator
GVWR
Fleet #
Unit #
FIRST LIENHOLDER #
SECOND LIENHOLDER #
Lien File No.
Lien Amount
Maturity Date
Date of Lien
Lien File No.
Lien Amount
Maturity Date Date of Lien
TAXES PAID:
FILING FEES:
ADDITIONAL COMMENTS
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____________________________________________________________________________________Clerks Initials_________________________