Please complete this form to submit a request for your personal reinstatement requirements. The following information is required for us to accurately identify your record and respond to you.

Request for Reinstatement Requirements - Colorado

Allow up to two business days for a reply. If you require more immediate assistance, contact Customer Service at 303-205-5613.

Today's Date: Tuesday, September 02, 2014

*First Name                         Middle Initial  *Last Name                                 
         
                                 
*Date of Birth:
*Month           *Day   *Year

         
*Social Security Number (Last four digits only)
 
 
Day Time Phone#


*Email Address

 
*Retype Email Address

   
*State of Residency

 
Colorado Driver's License or ID Number (if available)
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  Under penalty of perjury, I attest that I am the person of interest identified above requesting my reinstatement requirements.

I understand that use of this request form for any reason prohibited by law may subject me to civil penalties under federal and state law.

*Required Fields