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Get CO DR 2204 2010

Colorado. gov/revenue PERSONALIZED PLATE REPLACEMENT C. R.S. 42-3-211 To replace a special plate complete this form and return to Motor Vehicle Registration Denver CO 80261-0016 A replacement will be ordered and shipped directly to your county office. Truck Colorado Designer Personalized Alumni Personalized Street Rod Group Special Personalized 1st Plate Holder s Name as it appears on registration Last First Middle Day Time Phone 2nd Plate Holder s Name as it appears on registration Last First Middle Legal Colorado Address P. O. Boxes are not acceptable County City State ZIP Code Mailing Address If different than legal Reason for Replacement Lost Stolen Damaged I understand that if the personalized license plate configuration shown above has been reported lost or stolen that I or anyone operating my vehicle displaying this personalized plate may run the risk of being stopped questioned detained or other action taken by law enforcement. Departmental Use Only DR 2204 06/08/10 Colorado Department of Revenue division of Motor Vehicles registration section www. Plate Configuration Type of Plate Regular Personalized Call Letter Type of Vehicle i*e* Passenger Lt. Truck Colorado Designer Personalized Alumni Personalized Street Rod Group Special Personalized 1st Plate Holder s Name as it appears on registration Last First Middle Day Time Phone 2nd Plate Holder s Name as it appears on registration Last First Middle Legal Colorado Address P. O. Boxes are not acceptable County City State ZIP Code Mailing Address If different than legal Reason for Replacement Lost Stolen Damaged I understand that if the personalized license plate configuration shown above has been reported lost or stolen that I or anyone operating my vehicle displaying this personalized plate may run the risk of being stopped questioned detained or other action taken by law enforcement. By signing below I acknowledge that I have been informed of the risks associated with replacement of this personalized plate. I certify under penalty of perjury in the second degree that the above statements are true and accurate to the best of my knowledge and that I am a registered owner of these plates and request that they be replaced as indicated by this form* Signature Date Manufactured Incorrectly - No Charge approval must be obtained from State Registrations Signature of County Clerk Account number 15-25571 NO REFUNDS WILL BE GRANTED Make check payable to 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 insufficient or uncollected funds the Department of Revenue may collect the payment amount directly from your bank account electronically. Plate Type quantity price Amateur Call Letter Commercial Call Letter All Others 5900-800 Total Amount 48. Plate Configuration Type of Plate Regular Personalized Call Letter Type of Vehicle i*e* Passenger Lt. Truck Colorado Designer Personalized Alumni Personalized Street Rod Group Special Personalized 1st Plate Holder s Name as it appears on registration Last First Middle Day Time Phone 2nd Plate Holder s Name as it appears on registration Last First Middle Legal Colorado Address P. .

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