Get CO DR 2680 2006-2024

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. Signature of Driver affidavit Date NOTARY PUBLIC SECTION Subscribed and sworn before me this day of 20. My commission expires Seal Signature of Notary Public to be completed by an official of the driver s licensing authority in the DRIVER S LICENSING OFFICIAL state of residence. 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. Licensing Official s Name Title Phone Mailing Address IN ORDER FOR OUR DEPARTMENT TO ACCEPT THIS FORM ALL 3 SECTIONS MUST BE COMPLETED IN FULL*. 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. 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. 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. 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. Signature of Driver affidavit Date NOTARY PUBLIC SECTION Subscribed and sworn before me this day of 20. Signature of Driver affidavit Date NOTARY PUBLIC SECTION Subscribed and sworn before me this day of 20. My commission expires Seal Signature of Notary Public to be completed by an official of the driver s licensing authority in the DRIVER S LICENSING OFFICIAL state of residence. .