Colorado Dr 2395 Form – Fill Out and Use

DR 2395 (09/17/21)

COLORADO DEPARTMENT OF REVENUE

Division of Motor Vehicles

Application For Title and/or Registration

DMV.Colorado.gov

Title Section

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 Identification Number (VIN)

Fuel Type*:

*If electric, is it plug-in electric?

Yes

No

Year

Make

Body

Model

Color

CWT

Off-

Highway Vehicle

Snowmobile

Yes

No

Yes

No

Dealer #

Date Purchased

Commercial Use

MSRP

Size (W x

L)

Bus Cap.

Yes

No

Adult

Juvenile

Legal Name(s) as it Appears on Identification*

Lease

Legal Name(s) as it Appears on Identification

and Address of Owner(s) or Entity

Buy-Out

and Physical Address of Lessee

Yes

No

Indicate Alternate Address Here if The Registration Renewal Should be Sent to a Different Address

* DR 2421 Attached

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 Verifiable 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 traffic offense. Pursuant to 42-4-1409, C.R.S., the penalties for failure to have motor vehicle insurance coverage is a

Class 1 Misdemeanor Traffic Offense punishable by a mandatory minimum ten days imprisonment, or three hundred dollar fine, or both or a mandatory maximum

one year imprisonment, or one thousand dollar fine, or both shall be imposed by section 42-4-1701(3)(a)(II)(A), C.R.S.; and

a. A minimum mandatory fine of not less than five 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 five years following a prior conviction, a minimum mandatory fine of not less than one thousand dollars.

After obtaining a registration, you will be required to sign an affirmation clause indicating compliance with insurance requirements.

Unless a person waives his or her confidentiality, 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 Identification:

Secure and Verifiable ID of Owner/Agent:

Colorado DL

Colorado ID

Other:

ID#

Expires

DOB

The undersigned witness affirms that the named owner of the vehicle identified in this document presented the identification 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 __________________________