Glenwood Springs Police Department

AFFIDAVIT OF NON-RESPONSIBILITY

Vehicle sold or stolen?

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 NUMBER *:

STREET ADDRESS *:

CITY *:

STATE *:

ZIP CODE *:

Please choose one of the following *:

Vehicle was stolen before the date of the violation.Vehicle was sold before the date of the violation.

If you were not the driver of the vehicle, per Colorado Revised Statute 42-4-110.5 Section 2e, you are required to submit evidence that the owner was not the driver at the time of the alleged violation. To submit evidence that you were not the driver please schedule a hearing.

If you were not the driver and choose to identify the actual driver please complete the section below:

Name of actual driver:

Date of birth:

Driver's License Number:

Address:

City:

State:

Zip Code:

NOTE:

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.