Form Dr 6795 - Affidavit - Colorado Department Of Revenue printable pdf download

Form Dr 6795 - Affidavit - Colorado Department Of Revenue

DR 6795 (02/01)

AFFIDAVIT

COLORADO DEPARTMENT OF REVENUE

1375 Sherman Street

Denver, Colorado 80261

STATE OF __________________________________________ )

) S S

CITY AND COUNTY OF ______________________________ )

_________________________________________________ and ______________________________________________

(Name)

of lawful age, being first duly sworn upon (his/her/their) oath, depose(s) and say(s):

That (he/she/they) personally reside(s) at __________________________________________________________________

____________________________________________________________________________________________________

formerly at ______________________________________________________

_______________________________________________________________

_______________________________________________________________ and that the signature(s) as appearing on the

face or back of that certain State of Colorado Warrant Number: ___________________ Issue date: _______________ ,

in the sum of ______________________________________________________________ dollars ($___________._____ )

payable to the order of ______________________________________________________

________________________

(Name)

(Social Security Number)

_________________________________________________________________________

________________________

(Name)

(Social Security Number)

(is/are) forged, and (he/she/they) did not in any way benefit directly or indirectly from the cashing of said warrant, nor did

(he/she/they) at any time authorize anyone to sign (his/her/their) name(s) to such warrant, nor (was/were) said

endorsement(s) ratified or confirmed.

________________________________________________

(Signature)

________________________________________________

(Signature)

Subscribed and sworn to before me this ____________________ day of ______________________________________

______________________________________________

Notary Public

My commission expires ______________________________________________

Form Dr 6795 - Affidavit - Colorado Department Of Revenue