Form Dr 2701 PDF Details

Form Dr 2701 is a short, simple form that asks for your name, address and contact information. It's used to collect demographic data for planning and research purposes. You may be required to fill out this form if you're participating in a survey or study. The information on Form Dr 2701 is confidential and will not be shared with any third party without your consent. Completed forms should be returned to the researcher or mailed to the address listed on the form.

This table includes details about form dr 2701. You may look at it before writing the gaps.

QuestionAnswer
Form NameForm Dr 2701
Form Length2 pages
Fillable?Yes
Fillable fields34
Avg. time to fill out7 min 22 sec
Other namesscooter insurance colorado, form dr2701, dr2701, scooter application

Form Preview Example

DR 2579 (05/27/15)

COLORADO DEPARTMENT OF REVENUE

Division of Motor Vehicles

Registration Section

www.colorado.gov/revenue

Low-Power Scooter Agent Temporary Registration

Issuing Agent Use Only

Low-Power Scooter Registration Decal Number

 

 

 

 

 

 

Expire Month

Expire Year (three years from the purchase date)

 

 

 

 

 

 

 

 

 

 

 

 

C.R.S. 42-3-102(48.5), 42-2-103, 42-3-105, 42-3-311 & Code Of Colorado, Regulation 1 CCR 204-10 Rule 40. Low Power Scooter

This Form is to be used for Low-Power Scooter Registration Agent Use Only

Individual owners applying directly to the Department for Low-Power Scooter registration should complete the DR 2701 Low-Power Scooter Registration Application that can be accessed at www.colorado.gov/revenue

Low-Power Scooter Information

Vehicle Identification Number (VIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

Make

Model

 

 

Fuel Type

 

CC’s

 

CC’s or Wattage

Color

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wattage

 

 

 

 

 

Purchase Date

 

Low-Power Scooter Agent Name

 

 

 

 

Agent/Dealer Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner/Applicant Information

 

 

 

 

Owner/Applicant Last Name

 

 

 

 

Owner/Applicant First Name

 

 

 

 

 

 

 

 

 

Additional Owner/Applicant Last Name

Additional Owner/Applicant First Name

Additional Owner/Applicant Last Name

Additional Owner/Applicant First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

Legal Address (PO Boxes are not permitted)

 

City

 

 

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (If different from Legal Address)

 

City

 

 

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

 

 

 

Last Name as it appears on Identification

 

 

 

First Name as it appears on Identification

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Witness Printed Name

Date

Low-Power Scooter Registration Agent should complete this form in its entirety. Incomplete forms will be returned for correction. No refunds will be issued to the applicant by State Registrations. Applicant will be directed back to the LPS Registration Agent for refunds.

1.Validate the owners/customers Secure and Verifiable Identification.

2.Validate the owner’s proof of insurance for this Low-Power Scooter. Photocopy the proof of insurance for this Low-Power Scooter and mail in with this form. Do not send originals. Photocopy will not be returned.

3.Mail this form, photocopy of ownership document and photocopy of the proof of insurance to the address listed below:

Colorado Department of Revenue

Division of Motor Vehicles

PO Box 173350

Denver, CO 80217-3350

Affidavit of Low-Power Scooter Compliance

The following affidavit must be completed by the owner prior to submitting this form to register the Low-Power Scooter. The Low-Power

Scooter listed above meets the following criteria:

A self-propelled vehicle designed primarily for use on roadways with not more than three wheels in contact with the ground.

Has no manual clutch.

Has either of the following (check one):

A cylinder capacity not exceeding fifty cubic centimeters (50 cc’s) if powered by internal combustion; or

A wattage not exceeding four thousand four hundred seventy-six (4,476) if powered by electricity.

I swear or affirm in accordance with section 24-12-102, C.R.S., under penalty of perjury that I now have in effect a complying policy of motor vehicle insurance including an operator’s policy pursuant to part 6 of article 4 of title 10, C.R.S., or a certificate of self-insurance to cover the vehicle or operator of the vehicle for which this registration is issued. I understand that such insurance must be renewed so that coverage is continuous. Noncompliance is a misdemeanor traffic offense, that the minimum penalty for such offense is a five-hundred-dollar fine, and that the maximum penalty for such offense is one year’s imprisonment and a one-thousand-dollar fine.

Owner’s shall be required as a condition of obtaining a registration card to sign an affirmation clause that appears on the registration.

Signature of Owner (required)

Date

Instructions

Secure and Verifiable Identification (DR 2841) is required to obtain a registration in the State of Colorado. Low-Power Scooter registration may be issued by:

Division of Motor Vehicles, Registration Section, or,

A registered Low-Power Scooter Agent

Applicant

1.Submit the following:

The completed application on the reverse side of this form

A photocopy of the notarized Bill of Sale, Invoice or other proof of ownership — (photocopies will not be returned)

Check or Money Order made payable to the agent or Colorado Department of Revenue

2.You will receive a decal to be affixed to the frame that supports the seat of the Low-Power Scooter.

3.The operator of the Low-Power Scooter must have in their possession:

A valid Driver’s License or Minor Driver’s License;

A valid registration

Issuing Office

1.Verify all information completed by the applicant and obtain secure and verifiable identification (see form DR 2841) on the DR 2579 form or DR 2842 form.

2.Issue a numbered decal and indicate decal number assigned on the front of this form.

3.The original application is to be submitted to the Division of Motor Vehicle Registration Section. A copy of the completed application becomes the customer’s registration upon approval by the State of Colorado or authorized Low-Power Scooter agent.

4.Division of Motor Vehicles Registration Section — submit fee to Cashier Section. Low-Power Scooter Agent — submit fee and Low-Power Scooter Monthly Report to Division of Motor Vehicles, Registration Section.

5.A registered Low-Power Scooter Agent shall retain one dollar for each Low-Power Scooter registration.

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scooter registration SignatureofOwnerrequired, and Date fields to insert

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