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Motor Vehicle Requestor Release
Afdavit of Intended Use
DR 2489A (07/05/17)
COLORADO DEPARTMENT OF REVENUE
Division of Motor Vehicles
Title and Registration Section
www.colorado.gov/dmv
Section 1
Name of Person and/or Agency Requesting Information
Name
Address
City State ZIP
To purchase a record other than your own, you must declare
your intended use of that record, paraphrased below in Section
3, or you must have the signature of the person in interest
authorizing you to inspect the record. If you are acting as an
authorized user, you must identify the company or entity on
whose behalf you are requesting the record.
This application is subject to approval and additional information
/ documentation may be required. §42-1-206 C.R.S
Date: __________________
Section 2 - Name Search
First Name Last Name Middle Initial
Address
City County State ZIP
OR Vehicle Search
Vehicle Identication Number (VIN)
Year Make Body
Title (if available) or License Plate #
Section 3 (If no box is checked in section 3, applicant must check applicable box in section 3a)
Attached is a written consent of the person whose record is being requested using a Power of Attorney or Letter of Authorization from the
vehicle owner of record.
This is my record.
Section 3a - Information may be used only for the following approved, permissible, use: (must check 1 box only)
For use by any government agency, including any court or law enforcement agency, in carrying out it’s functions, or any private person or entity
acting on behalf of a Federal, State, or Local Government agency in carrying out its functions;
An agency charged with driver/motor vehicle safety or theft including: motor vehicle product alterations, recalls, advisories, motor vehicle performance monitoring,
m
otor vehicle parts/dealers, motor vehicle market research or surveys, removal of non-owner records from original records of motor vehicle manufacturers
A business that conducts research activities, and for use in producing statistical reports, so long as the personal information is not published,
re-disclosed, or used to contact the parties in 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
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. Copy of tow ticket is required.
Research activity to verify if record is “Junk”, “Salvage”, or “Rebuilt from Salvage”. Copy of ownership document is required.
Bonding for Colorado title or Application for Assigned ID. Copy of a DR 2704 Certified VIN Inspection are required
By a business that will use the information to verify the accuracy of information submitted by individuals for the purpose of preventing fraud,
pursuing legal remedies against, or recovering a debt or security interest.
By an insurer, or a salvage pool that is licensed as a Colorado used motor vehicle dealer, that is subject to an insurance claim or being
possessed by a salvage pool.
Section 4 - Additional Information (check if Applicable)
Attorney Bar Number
Licensed Private Investigator & Investigative
Agency or security Service
License Number State Expires On
Process Server Copy of the front page of Summons must be attached
Court Order Copy of the front page of Court Order must be attached
Insurance
Company
Claim
Number
Automobile Dealer/Auction License Number
Tow Carrier or Repair Facility
Company Name
PUC T
Number
Law Enforcement Agency
Section 5
Under Penalty of Perjury, I attest that I shall not obtain, re-sell, transfer, or use the information in any manner prohibited by law. I understand that motor
vehicle records that are obtained, resold, or transferred for purposes prohibited by law may subject me to civil penalties under federal and state law.
Print Name Driver's License Number Badge Number State
Signature Date
