Dr 2489 Form – Fill Out and Use This PDF

	DR 2489 (06/22/16)
			Search Fee $9.00
	COLORADO DEPARTMENT OF REVENUE
	Division of Motor Vehicles		Certiied fee (additional) $1.00
	Driver Control, Room 164
	PO Box 173350
	Denver, CO 80217-3350	Requestor Release and Afidavit of Intended Use
	www.colorado.gov/revenue

Records and/or other requests are available at 1881 Pierce St., Lakewood, CO. The Department or the Department's authorized agent

shall deny inspection of any motor vehicle record to any person, other than a person in interest, or a federal, state, or local government agency carrying out its oficial functions, who has not signed and returned the Afidavit of Intended Use. (§42-1-206 and §24-72-204, C.R.S.)(Driver Privacy Protection Act 18USC 2721)

Driver Information

Record/Clearance Letter	Application		Accident Report		Ticket # _____________			Other ________________
Name of Driver
License Number							Date of Birth
			Vehicle Information
Name Search
License Plate Number						Vehicle Identiication Number (VIN)
Accident Information (driver's information section must be completed)
Police Department				Report Number or Case Number
Date of Accident		Accident Location					City/County

To purchase a record other than your own, you must declare your intended use of that record, paraphrased below, or you must have the signature of the person in interest authorizing you to inspect the record. If you are acting as an agent for an authorized

user, you must identify the company or entity on whose behalf you are requesting the record.

INFORMATION MAY BE USED ONLY FOR THE FOLLOWING APPROVED PERMISSIBLE USE: (CHECK 1 BOX ONLY)

By a government agency, including any court or law enforcement agency performing its functions for an approved purpose under DPPA.

By an agency charged with driver/motor vehicle safety or theft including: MV product alterations, recalls, advisories, MV performance monitoring, MV parts/dealers, MV market research or surveys, removal of non-owner records from original

owner records of MV manufacturers.

By a business that will use the information to verify the accuracy of information submitted by individuals for the purposes of preventing fraud, pursuing legal remedies against or recovering a debt or security interest.

In connection with a civil, criminal, administrative or arbitral proceeding in any court or before a self-regulatory body,

including process service, investigation, execution of judgment, or pursuant to a court order.

In research activities (the information may not be published, redisclosed, or used to contact the parties).

By an insurer or insurance support agency in connection with claims, investigations, anti-fraud activities, rating or

underwriting.

To provide notice to owners of towed or impounded vehicles.

By an employer/agent or insurer of a Commercial Driver's License holder.

In the operation of private toll facilities.

Attached is a written consent of the person whose record is being requested.

Under penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited by law. I understand that motor vehicle or driver records that are obtained, resold, or transferred for purposes prohibited by law may

subject me to civil penalties under federal and state law.

Printed Name

(For mailed requests, please allow 7-10 working days to process after received by Department)