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Colorado Out of State Residency Affidavit Form

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This form is provided by Colorado Department of Revenue.

Colorado Out of State Residency Affidavit Form
Colorado Out of State Residency Affidavit Form
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.)
DRIVER SECTION:
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 Address Date of Birth
City State ZIP Code
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
Seal
DRIVER’S LICENSING OFFICIAL:
to be completed by an official of the driver’s licensing authority in the
state of residence.
State Date
Licensing Official’s Name Title
Licensing Official’s Signature Phone
Mailing Address
City State ZIP Code
( )
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.
Colorado Out of State Residency Affidavit Form