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Check and complete at least one: The inaccuracy or defect to be corrected is (include Department of State form name and date filed):. Enter the name and mailing address to which any correspondence regarding this filing should be sent.The form must be completed on a computer or typewriter. The enclosed Statement of Correction and fee(s) are submitted for filing. Complete the entire form and enter all requested information in the fields provided. Use these instructions when completing a Statement of Correction Revoking a Filed Document pursuant to § 7-90-305 of the Colorado Revised Statutes (C.R.S.). Complete and include this form with your paper submission. This information only will be used to communicate in writing about the submission, if needed. When properly completed, send Filing Office Copy to filing office. Requirements. Complete this application when there is an error on the assignment of a Massachusetts Certificate of Title. Instructions.