In today’s digital age, the threat of identity theft looms larger than ever, particularly when it pertains to personal identification documents essential for daily transactions and legal validations. The Colorado Department of Revenue, Division of Motor Vehicles Investigations Unit, has put forth the DR 2153 form as a crucial tool in the fight against such illicit activities, specifically targeting the theft of Colorado driver’s licenses or identification cards. This notarized affidavit is a procedural document that must be completed and presented, accompanied by a police report, at a driver's license office to facilitate the issuance of a new license or ID number (PIN), hence mitigating the risks and consequences of identity theft. It painstakingly collates information regarding the victim’s identification, the circumstances of the fraud—including how the identity theft transpired—and the steps taken by the victim towards reporting the crime to law enforcement agencies. Furthermore, by underscoring the legal implications of submitting false information—subjecting violators to potential criminal prosecution for perjury—the form underscores the seriousness with which the state of Colorado regards the protection of its residents' identities. Through this comprehensive approach, the DR 2153 form serves not only as a remedial measure for victims but also as a deterrent to potential identity thieves.
| Question | Answer |
|---|---|
| Form Name | Colorado Form Dr 2153 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | co theft form, colorado theft form, dr 2153 form, colorado form dr 2153 |
DR 2153 (11/13/07)
COLORADO DEPARTMENT OF REVENUE DIVISION OF MOTOR VEHICLES INVESTIGATIONS UNIT
1881 PIERCE STREET, ROOM 136 LAKEWOOD, COLORADO 80214 (303)
AFFIDAVIT OF
COLORADO DRIVER'S LICENSE
OR ID THEFT
Take (DO NOT MAIL OR FAX) this completed, notarized form
with a police report to a driver’s license office to apply for a license or ID with a new number (PIN).
VICTIM IDENTIFICATION
Note: Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.
FULL LEGAL NAME
First
Middle
Last
Jr. Sr. III
NAME (IF DIFFERENT FROM ABOVE) WHEN THE EVENTS DESCRIBED IN THIS AFFIDAVIT TOOK PLACE
First |
Middle |
Last |
|
|
Jr. |
|
Sr. |
|
III |
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
Date of Birth
Social Security Number
Driver's license or Identification card number (PIN)
CURRENT ADDRESS
Address
State
|
City |
|
ZIP Code |
Beginning date of residence at this address: |
|
|
Month |
Year |
|
|
|
ADDRESS (IF DIFFERENT FROM ABOVE) WHEN THE EVENTS DESCRIBED IN THISAFFIDAVIT TOOK PLACE
Address |
|
City |
|
|
|
|
|
|
|
|
|
|
|||||
State |
ZIP Code |
Beginning and End date of residence at this address: |
|
|||||
|
|
From: |
Month |
Year |
|
To: |
Month |
Year |
Current Daytime Telephone Number |
|
Current Evening Telephone Number |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
HOW THE FRAUD OCCURRED |
Check all that apply for items |
||||||
|
|
1.I did not authorize anyone to use my name or personal information to seek the money, credit, loans, goods or |
||||
|
|
|||||
|
|
|
services described in this report. |
|||
|
|
|
||||
|
I did not receive any benefit, money, goods or services as a result of the events described in this report. |
|||||
|
|
2. |
||||
|
|
|
My identification documents (for example, credit cards, birth certificate, driver's license, Social Security card, etc.) were |
|||
|
||||||
|
|
3. |
||||
|
|
|
|
stolen |
|
lost on or about _______________________________________________________(month/day/year) |
|
|
|
|
|
||
|
|
|
|
|
||
|
|
|
|
|
|
|
4. To the best of my knowledge and belief, the following person(s) used my information (for example, my name, address, date of birth, existing account numbers, Social Security number, mother’s maiden name, etc.) or identification documents to get money, credit, loans, goods or services without my knowledge or authorization:
Name
Address (if known)
Phone Number(s)
Additional Information
Name
Address (if known)
Phone Number(s)
Additional Information
5.I do not know who used my information or identification documents to get money, credit, loans, goods or services without my knowledge or authorization.
6.Additional comments (For example, description of the fraud, which documents or information were used or how the identity thief gained access to your information.)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
_____________________________________________________________ (Attach additional pages as necessary.)
VICTIM’S LAW ENFORCEMENTACTIONS
7.My signature below indicates that I am willing to assist in the prosecution of the person(s) who committed this fraud.
8.My signature below authorizes the release of this information to law enforcement for the purpose of assisting them in the investigation and prosecution of the persons who committed this fraud.
9.(check all that apply) I have reported the events described in this affidavit to the police or other law enforcement
agency. The police
did
did not write a report. Please complete the following:
Agency Number 1
Officer/Agency personnel taking report
Date of report
Report number, if any
Phone number
Agency Number 2
Officer/Agency personnel taking report
Date of report
Report number, if any
Phone number
Please indicate the supporting documentation you are able to provide.Attach copies (NOT originals) to the affidavit. Acopy of the report filed with the police or sheriff’s department is attached.
SIGNATURE
I declare under penalty of perjury that the information I have provided in this affidavit is true and correct to the best of my knowledge. I understand that if I give a false statement, my driver's license or identification card may be canceled and denied, in accordance with §
Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.
Signature__________________________________________________Date signed _____________________________
Subscribed and sworn to before me in the County of _________________________________________, State of Colorado,
this_______________________________________ day of ________________________________, 2 ______________
Notary Public________________________________________________ My commission expires ___________________