Permission for Release of Records

Record information available at Driver License offices and 1881 Pierce St.

All other requests available only at 1881 Pierce St., Lakewood, CO.

I hereby authorize the release of records maintained by the Colorado Department of

Revenue, Motor Vehicle Division pursuant to the Driver's Privacy Protection Act (18

USC 2721) and Colorado law (42-72-204, 42-1-206, 42-3-125 CRS).

**Fill out this section**

Printed Name __________________________________________________________________

Signature _________________________________________ Date ________________________

Date of Birth _____________________ License Number ________________________________

Purpose for which records are released ______________________________________________

______________________________________________________________________________

**Leave this section blank**

Requestor's Name ______________________________________________________________

Company _____________________________________________________________________

Address ______________________________________________________________________

City __________________________State ___________________Zip code________________

Signature of Requestor _______________________________________ Date ________________