Fillable INFORMATION AND ATTESTATION CLAUSE SUPPLEMENTAL SECURE AND VERIFIABLE (Ouray County)

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INFORMATION AND ATTESTATION CLAUSE SUPPLEMENTAL SECURE AND VERIFIABLE (Ouray County)

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DR 2842 (01/26/11)
COLORADO DEPARTMENT OF REVENUE
DIVISION OF MOTOR VEHICLES
TITLE AND REGISTRATION SECTIONS
www.colorado.gov/revenue
SUPPLEMENTAL SECURE AND VERIFIABLE IDENTIFICATION
INFORMATION AND ATTESTATION CLAUSE
ANY ALTERATION OR ERASURE VOIDS THIS DOCUMENT
This form may be used as an attachment to existing forms inventory which does not contain the secure and veriable
identication information or attestment. Please attach this completed form to the document(s) being presented for
Title and/or Registration.
SECURE AND VERIFIABLE IDENTIFICATION OF
Name as it Appears on Identication
Agency (If Applicable)
Identication Information (for acceptable forms of ID please see form DR 2841)
Colorado DL Colorado ID Other _________________________________________
ID # Expires DOB
This section to be used with DR 2219 Persons with Disabilities Parking Privileges Application.
Identication shown above belongs to:
Individual (Placard holder) Guardian Parent Business
* Afdavit of one in the same is required if the name on ID differs in any way from name on title assignment.
*
________________________________________________________________________________________
and _____________________________________________________________________________________
ARE ONE IN THE SAME PERSON COMPANY
I, certify under penalty of perjury in the second degree, that the above statements are true and accurate to the best of
my knowledge.
Signature
The undersigned witness afrms that the identication described above was presented to me.
Witness Printed Name
Witness Signature Date
DR 2841 (01/26/11)
COLORADO DEPARTMENT OF REVENUE
DIVISION OF MOTOR VEHICLES
TITLE AND REGISTRATION SECTIONS
www.colorado.gov/revenue
Secure and Veriable ID
Secure and Veriable ID is required to obtain:
• New Titles
• Duplicate Titles (vehicles purchased on or after 07/01/2006)
• New Registrations
• New Temporary Registration Permits
• New Placards
The following types of identication are Secure and Veriable:
• Any Colorado Driver License, Colorado Driver Permit or Colorado Identication
Card, current or expired one year or less. (Valid temporary paper license with in-
valid Colorado Driver’s License, Colorado Driver’s Permit, or Colorado Identication
Card, expired one year or less is acceptable.)
• Out-of-state issued photo driver’s license or photo identication card, photo driver’s
permit current or expired one year or less.
• U.S. Passport current or expired less than 10 years.
• Valid foreign passport with I-94 or valid processed for I551 stamps. Valid I-94 is-
sued by Canadian government with L1 or R1 status and a valid Canadian drivers
license or valid Canadian identication card.
• Valid I551 Resident Alien/Permanent Resident card. No border crosser or USA B1/
B2 Visa/BCC cards.
• Valid I688 Temporary Resident, I688B, and I766 Employment Authorization Card
with intact photo.
• Valid US Military ID (active duty, dependent, retired, reserve and National Guard).
• Tribal Identication Card with intact photo. (U.S. or Canadian)
• Certicate of Naturalization with intact photo.
• Certicate of (US) Citizenship with intact photo.
If you have questions about Secure and Veriable Identication, please contact the Title and
Registration Sections at 303-205-5608.
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INFORMATION AND ATTESTATION CLAUSE SUPPLEMENTAL SECURE AND VERIFIABLE (Ouray County)

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Completed 25 January 2021

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