State of Colorado
Unrecovered Theft Title Application
C.R.S. 42-6-102 (16)
ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT
Unrecovered Theft Title Unrecovered Theft Salvage
This application is to be used to establish title or salvage title in anticipation of the recovery of a vehicle that has been reported stolen.
Vehicle Identication Number (VIN) Year Make Body Model Color
Date Purchased Fuel Type MSRP Odometer Reading and Indicator
CWT Bus Cap.
Adult
Juvenile __________ No. of Seats
Trailers and Manufactured Homes Size (W x L) Dealer Number
Owner/Entity Name
Owner 2/Entity Name
Legal Address City State ZIP
Mailing Address (If different than legal address) City State ZIP
Note: 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.
Acknowledgement of intent for joint tenancy with the rights of survivorship is required
for all owners (C. R. S. 38-11-101)
Print Name Owner 1 (Print Name) Owner 1 Signature Date
Request the Colorado Certicate of Title with the above Vehicle Identication Number (VIN) to be issued in: (check one)
Joint Tenancy with Rights of Survivorship
Tenancy in Common
I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my knowledge.
Owner 2 (Print Name) Owner 2 Signature Date
Request the Colorado Certicate of Title with the above Vehicle Identication Number (VIN) to be issued in: (check one)
Joint Tenancy with Rights of Survivorship
Tenancy in Common
I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my knowledge.
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 motor vehicle described above is an unrecovered theft. There are no
liens outstanding against this vehicle.
Owner/Agent as it appears on Identication (Print Name) Owner or Agent Signature Date
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
MAKE CHECK OR MONEY ORDER PAYABLE TO:
Colorado Department of Revenue, Denver, CO 80261-0007
NO REFUNDS WILL BE GRANTED FOR REQUESTS
The state may convert your check to a one time electronic banking transaction. Your bank account
may be debited as early as the same day received by the State. If converted, your check will not
be returned. If your check is rejected due to insufcient or uncollected funds, the Department of
Revenue may collect the payment amount directly from your bank account electronically.
Account Number M1525571
5750
TOTAL
AMOUNT
(999)
$7.20
DR 2593 (07/14/15)
COLORADO DEPARTMENT OF REVENUE
Division of Motor Vehicles
Title Section
www.colorado.gov/revenue
Departmental Use Only
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit