AFFIDAVIT OF NON-RESPONSIBILITY

Email Address:

Complete this field if you wish to receive a copy of your submission.

Citation recipient information

Today's Date *:

CITATION NUMBER *:

PLATE NUMBER *:

FIRST NAME *:

LAST NAME *:

DATE OF BIRTH *:

EMAIL ADDRESS: *:

PHONE *:

STREET ADDRESS *:

CITY *:

STATE *:

Zip Code *:

Please choose one of the following. Then fill out the appropriate section below. *:

I was not the driver.The vehicle was sold before the date of the violation.

I was not the driver.

Please provide proof that you were not the driver of this vehicle at this date and time of this violation. You may identify the actual driver in the provided space below.

Upload drivers license: ⓘ

Maximum file size: 5MB

The vehicle was sold before the date of the violation.

Maximum file size: 5MB

Submit any TWO of the following: bill of sale, cancellation of insurance for the vehicle, or cancellation of the plate registration with the DMV.: ⓘ

Maximum file size: 5MB

Identify the actual driver, fill out the following information:

Name of actual driver:

Date of Birth:

Driver's License Number:

Address:

City:

State:

Zip Code:

NOTE:

The affidavit and supporting documentation will be reviewed and a determination made regarding identity of the actual driver. Keep in mind that providing an affidavit will NOT automatically result in the closure of this matter. If further information is required, you will be notified. Any false representation may subject you to criminal penalties.

Declaration Under Penalty of Perjury *:I swear or affirm under penalty of perjury, that the information provided in this affidavit is true and correct to the best of my knowledge.

Glenwood Springs Police Department