DR 2395 (04/02/15)
COLORADO DEPARTMENT OF REVENUE
Division of Motor Vehicles
Title Section
www.colorado.gov/revenue
Application For Title and/or Registration
C.R.S. 42-3-105, 42-3-304(25)(c), 42-6-107, 42-6-116, 42-6-117
Any Alteration or Erasure may Void this Document
Vehicle Identication Number (VIN)
Fuel Type*:
*If electric, is it plug-in electric?
Yes No
Year Make Body Model Color CWT Off-Highway Vehicle
Yes No
Snowmobile
Yes No
Dealer # Date Purchased Commercial Use
Yes No
MSRP Size (W x L) Bus Cap.
Adult Juvenile
Legal Name(s) as it Appears on Identication*
and Address of Owner(s) or Entity
* DR 2421 Attached
Lease
Buy-Out
Yes No
Legal Name(s) as it Appears on Identication
and Physical Address of Lessee
Indicate Alternate Address Here if The Registration Renewal Should be Sent to a Different Address
First Lienholder Name and Address or ELT E- Number Second Lienholder Name and Address**
Lien Amount Lien Amount
Indicate Alternate Address Here if The Title Should be Sent to a Different Lienholder Address Indicate Alternate Address Here if The Title Should be Sent to a Different Lienholder Address
*
DR 2421 Statement of One in the Same is required when the owner’s name on the Secure and Veriable ID differs from the owner’s name on the application/title.
**If more than two lienholders, please attach separate documentation.
Motor vehicle insurance or operator's coverage is compulsory in the State of Colorado. Proof of insurance is required prior to issuance of a registration. Non-compli-
ance with this requirement is a misdemeanor trafc offense. Pursuant to 42-4-1409, C.R.S., the penalties for failure to have motor vehicle insurance coverage is a
Class 1 Misdemeanor Trafc Offense punishable by a mandatory minimum ten days imprisonment, or three hundred dollar ne, or both or a mandatory maximum
one year imprisonment, or one thousand dollar ne, or both shall be imposed by section 42-4-1701(3)(a)(II)(A), C.R.S.; and
a. A minimum mandatory ne of not less than ve hundred dollars or greater if imposed by the court; and
b. At the discretion of the court, not less than forty hours of community service, subject to the provisions of section 18-1.3-507, C.R.S.
c. A second or subsequent conviction within a period of ve years following a prior conviction, a minimum mandatory ne of not less than one thousand dollars.
After obtaining a registration, you will be required to sign an afrmation clause indicating compliance with insurance requirements.
Unless a person waives his or her condentiality, the information contained in the person’s motor vehicle record shall not be used for any purpose other than a
purpose authorized by law, pursuant to C.R.S. 42-2-121 (4)(a).
I certify, under penalty of perjury in the second degree, that the above information is true and accurate to the best of my knowledge.
Owner or Agent Signature Date
Printed name of Owner/Agent as it appears on Identication:
Secure and Veriable ID of Owner/Agent:
Colorado DL Colorado ID Other:
ID# Expires DOB
The undersigned witness afrms that the named owner of the vehicle identied in this document presented the identication described above.
Witness Signature Date
County Use Only (Dealers/Lienholders: Do Not Write Below this Line)
Previous Title Number Title Number
Date Accepted Purchase Price Odometer Reading & Indicator GVWR Fleet # Unit #
First Lienholder # Second Lienholder #
Lien File No. Lien Amount Maturity Date Date of Lien Lien File No. Lien Amount Maturity Date Date of Lien
Taxes Paid: Filing Fees:
Additional Comments:
________________________________________________________________________________________________________________________
___________________________________________________________________________________ Clerks
Initials
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