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This form is provided by Colorado Department of Revenue.
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.)
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 AddressDate of Birth
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.
NOTARY PUBLIC SECTION:
Subscribed and sworn before me this ___________________________ day of __________________________, 20_____.
My commission expires
Signature of Notary Public
DRIVER’S LICENSING OFFICIAL:
to be completed by an official of the driver’s licensing authority in the
state of residence.
Licensing Official’s NameTitle
Licensing Official’s SignaturePhone
Signature of Driver (affidavit)Date
IN ORDER FOR OUR DEPARTMENT TO ACCEPT THIS FORM,
ALL 3 SECTIONS MUST BE COMPLETED IN FULL.
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.
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