CHANGE OF NAME
January 2019
FORM
5
Colorado Department of Law
Criminal Justice Section, POST Board
1300 Broadway 9
th
Floor
Denver, CO 80203
post@coag.gov
720-508-6721 FAX 866-858-7486
Name: ___________________________________________________________________________________________
(as listed on original certification) Last First Middle
Email Address: _____________________________________________
POST PID #: _________________________ (000000 or 0000-0000)
Date of Birth: ________________________ Gender: M F Other
Complete all information below for the reported change(s), as applicable:
_______________________________________________________________________________________________
New Last Name New First New Middle
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS AFFIDAVIT AND ACCOMPANYING
DOCUMENTS, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, THEY ARE TRUE, CORRECT, AND COMPLETE.
I FURTHER ACKNOWLEDGE THAT ANY FALSE STATEMENT, MISSTATEMENT, OR INACCURACY MAY RESULT IN
REVOCATION OF MY CERTIFICATION, AS WELL AS CRIMINAL PROSECUTION.
_______________________________________________________________ Date: _____________________
Applicant's Signature
Please scan and email, fax, or mail a copy of this completed form WITH NAME
CHANGE DOCUMENTATION (Driver’s license, marriage license, court order, etc.) to
the above email/address/fax number.
ADDRESS CHANGES CAN BE COMPLETED USING THE POST PORTAL.
https://copost-portal.acadisonline.com/AcadisViewer/Login.aspx?ShowSessionTimeout=true
Your username is your email address (personal or agency). Please disable your popup blocker prior
to resetting password and use browser other than Internet Explorer. Please contact POST if you do
not have portal access.