Blank Colorado Dr 2153 PDF Form

Blank Colorado Dr 2153 PDF Form

The Colorado DR 2153 form serves as an affidavit for individuals who have experienced driver's license or ID theft. This essential document allows victims to apply for a new license or ID number after reporting the theft to law enforcement. To initiate this process, complete the form and submit it in person at a driver's license office.

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The Colorado DR 2153 form is an essential document designed for individuals who have fallen victim to identity theft, specifically concerning their driver's license or state identification. This affidavit serves as a formal declaration that allows victims to report the unauthorized use of their personal information. By completing this notarized form and submitting it along with a police report, victims can apply for a new driver's license or ID number, helping to restore their identity and protect against further fraud. The form requires detailed personal information, including the victim's full legal name, date of birth, and social security number, as well as specifics about how the theft occurred. Victims must indicate whether they authorized the use of their personal information and provide any known details about the perpetrator. Additionally, the form emphasizes the importance of truthfulness; knowingly providing false information can lead to serious legal consequences, including charges of perjury. Ultimately, the DR 2153 form is a vital tool in the fight against identity theft, empowering victims to take action and seek justice.

Document Sample

DR 2153 (11/13/07)

COLORADO DEPARTMENT OF REVENUE DIVISION OF MOTOR VEHICLES INVESTIGATIONS UNIT

1881 PIERCE STREET, ROOM 136 LAKEWOOD, COLORADO 80214 (303) 205-8383

AFFIDAVIT OF

COLORADO DRIVER'S LICENSE

OR ID THEFT

Take (DO NOT MAIL OR FAX) this completed, notarized form

with a police report to a driver’s license office to apply for a license or ID with a new number (PIN).

VICTIM IDENTIFICATION

Note: Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.

FULL LEGAL NAME

First

Middle

Last

Jr. Sr. III

NAME (IF DIFFERENT FROM ABOVE) WHEN THE EVENTS DESCRIBED IN THIS AFFIDAVIT TOOK PLACE

First

Middle

Last

 

 

Jr.

 

Sr.

 

III

 

 

 

 

 

 

 

 

 

 

Date of Birth

Social Security Number

Driver's license or Identification card number (PIN)

CURRENT ADDRESS

Address

State

 

City

 

ZIP Code

Beginning date of residence at this address:

 

Month

Year

 

 

 

ADDRESS (IF DIFFERENT FROM ABOVE) WHEN THE EVENTS DESCRIBED IN THISAFFIDAVIT TOOK PLACE

Address

 

City

 

 

 

 

 

 

 

 

 

State

ZIP Code

Beginning and End date of residence at this address:

 

 

 

From:

Month

Year

 

To:

Month

Year

Current Daytime Telephone Number

 

Current Evening Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW THE FRAUD OCCURRED

Check all that apply for items 1-6:

 

 

1.I did not authorize anyone to use my name or personal information to seek the money, credit, loans, goods or

 

 

 

 

 

services described in this report.

 

 

 

 

I did not receive any benefit, money, goods or services as a result of the events described in this report.

 

 

2.

 

 

 

My identification documents (for example, credit cards, birth certificate, driver's license, Social Security card, etc.) were

 

 

 

3.

 

 

 

 

stolen

 

lost on or about _______________________________________________________(month/day/year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. To the best of my knowledge and belief, the following person(s) used my information (for example, my name, address, date of birth, existing account numbers, Social Security number, mother’s maiden name, etc.) or identification documents to get money, credit, loans, goods or services without my knowledge or authorization:

Name

Address (if known)

Phone Number(s)

Additional Information

Name

Address (if known)

Phone Number(s)

Additional Information

5.I do not know who used my information or identification documents to get money, credit, loans, goods or services without my knowledge or authorization.

6.Additional comments (For example, description of the fraud, which documents or information were used or how the identity thief gained access to your information.)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_____________________________________________________________ (Attach additional pages as necessary.)

VICTIM’S LAW ENFORCEMENTACTIONS

7.My signature below indicates that I am willing to assist in the prosecution of the person(s) who committed this fraud.

8.My signature below authorizes the release of this information to law enforcement for the purpose of assisting them in the investigation and prosecution of the persons who committed this fraud.

9.(check all that apply) I have reported the events described in this affidavit to the police or other law enforcement

agency. The police

did

did not write a report. Please complete the following:

Agency Number 1

Officer/Agency personnel taking report

Date of report

Report number, if any

Phone number

E-mail address, if any

Agency Number 2

Officer/Agency personnel taking report

Date of report

Report number, if any

Phone number

E-mail address, if any

Please indicate the supporting documentation you are able to provide.Attach copies (NOT originals) to the affidavit. Acopy of the report filed with the police or sheriff’s department is attached.

SIGNATURE

I declare under penalty of perjury that the information I have provided in this affidavit is true and correct to the best of my knowledge. I understand that if I give a false statement, my driver's license or identification card may be canceled and denied, in accordance with § 42-2-122, C.R.S. I also understand that if I am convicted of perjury in the first or second degree, the Department shall immediately revoke my driver's license or identification card, in accordance with § 42-2-125, C.R.S.

Knowingly submitting false information on this form could subject you to criminal prosecution for perjury.

Signature__________________________________________________Date signed _____________________________

Subscribed and sworn to before me in the County of _________________________________________, State of Colorado,

this_______________________________________ day of ________________________________, 2 ______________

Notary Public________________________________________________ My commission expires ___________________

File Specifics

Fact Name Description
Form Purpose The Colorado DR 2153 form is used to report identity theft related to a driver's license or ID.
Submission Guidelines This form must be completed and notarized, then submitted in person to a driver’s license office along with a police report.
Victim Identification Victims must provide their full legal name, date of birth, Social Security number, and current address on the form.
Fraud Reporting Victims can check various boxes to indicate how the fraud occurred, including unauthorized use of personal information.
Law Enforcement Actions Victims must indicate if they have reported the fraud to law enforcement and provide details of the report.
Legal Consequences Providing false information on this form can lead to criminal prosecution for perjury under Colorado law.
Governing Laws This form is governed by Colorado Revised Statutes § 42-2-122 and § 42-2-125.

How to Use Colorado Dr 2153

After gathering the necessary information, you will need to fill out the Colorado DR 2153 form accurately. This completed form, along with a police report, must be taken to a driver’s license office to apply for a new license or ID number. Ensure that all sections are filled out completely and truthfully to avoid complications.

  1. Begin with Victim Identification:
    • Enter your full legal name, including first, middle, and last names. Indicate if you are a Jr., Sr., or III.
    • If your name is different from the one above, provide that name as well.
    • Fill in your date of birth and Social Security number.
    • Input your driver’s license or identification card number (PIN).
    • Provide your current address, including street, city, state, and ZIP code.
    • Indicate the beginning date of residence at this address (month and year).
    • If your address is different from the current one, fill in that address and provide the city, state, and ZIP code.
    • List the beginning and end dates of residence at the previous address (from month/year to month/year).
    • Include your current daytime and evening telephone numbers.
  2. Describe How the Fraud Occurred:
    • Check all applicable boxes for items 1-6 that describe how the fraud occurred.
    • For item 3, indicate the date your identification documents were lost or stolen.
    • If known, provide the names, addresses, and phone numbers of individuals who used your information fraudulently.
    • If you do not know who used your information, check the appropriate box.
    • In the comments section, provide a detailed description of the fraud, including which documents were used and how access was gained.
  3. Victim’s Law Enforcement Actions:
    • Sign the section indicating your willingness to assist in prosecution.
    • Authorize the release of your information to law enforcement.
    • Indicate whether you have reported the fraud to law enforcement and whether a report was written.
    • Complete the details for the police agency, including officer name, date of report, report number, phone number, and email address, if applicable.
    • List any supporting documentation you are providing, such as a copy of the police report.
  4. Sign and Notarize:
    • Sign and date the affidavit, confirming the truthfulness of the information provided.
    • Have the form notarized, including the county and state where it is signed, along with the notary’s commission expiration date.

Your Questions, Answered

What is the purpose of the Colorado DR 2153 form?

The Colorado DR 2153 form, also known as the Affidavit of Colorado Driver's License or ID Theft, is designed for individuals who have experienced identity theft related to their driver's license or identification card. By completing this form, victims can apply for a new license or ID number. This process requires the submission of the notarized form along with a police report to a driver's license office. It is essential for victims to provide accurate information to avoid legal repercussions.

How do I complete the DR 2153 form?

To complete the DR 2153 form, follow these steps:

  1. Fill in your full legal name and any other names used.
  2. Provide your date of birth, Social Security number, and current driver's license or ID number.
  3. List your current address and any previous addresses related to the identity theft.
  4. Indicate how the fraud occurred by checking the relevant boxes and providing additional details if necessary.
  5. Sign the form to confirm your willingness to assist law enforcement and to authorize the release of your information for their investigation.
  6. Attach a copy of the police report and any other supporting documentation.

Once completed, do not mail or fax the form; instead, take it to a driver’s license office in person.

What should I do if I do not know who committed the identity theft?

If you are unsure who used your personal information, you can indicate this on the form. There is a specific section where you can check a box stating that you do not know who used your information. It is important to provide as much detail as possible about the fraud, including any stolen documents or information. This will assist law enforcement in their investigation, even if you do not have a specific suspect.

What happens if I provide false information on the DR 2153 form?

Providing false information on the DR 2153 form can lead to serious consequences. Knowingly submitting incorrect details may result in criminal prosecution for perjury. Additionally, if the Department of Revenue finds that you have given false statements, your driver's license or identification card may be canceled or denied. It is crucial to ensure that all information provided is accurate and truthful to avoid these legal issues.

Common mistakes

  1. Incomplete Personal Information: Failing to provide your full legal name, date of birth, or Social Security number can lead to delays in processing your application. Ensure all fields are filled out accurately.

  2. Incorrect Address Details: Providing the wrong current or previous address can complicate the verification process. Double-check that all addresses are correct and match official documents.

  3. Missing Notarization: The form must be notarized before submission. Omitting this step will result in the rejection of your application. Always ensure you have a notary public complete this step.

  4. Failure to Report to Law Enforcement: Not reporting the theft to the police can hinder your application. You must provide a police report to proceed with obtaining a new license or ID.

  5. Omitting Supporting Documentation: Forgetting to attach necessary documents, such as the police report, can delay your application. Always include copies of any relevant reports or evidence.

  6. Providing False Information: Submitting incorrect or misleading information can lead to criminal charges. Be honest and accurate in all your responses to avoid serious legal consequences.

Documents used along the form

When dealing with identity theft and the subsequent need for a new driver's license or ID in Colorado, the DR 2153 form is often accompanied by several other important documents. These forms help to establish a clear record of the theft and support your application for a new identification document. Below is a list of commonly used forms alongside the Colorado DR 2153.

  • Police Report: This document is essential as it provides official evidence of the identity theft. It should detail the circumstances of the theft and any actions taken by law enforcement. A copy of this report must accompany the DR 2153 form.
  • Identity Theft Affidavit: This affidavit is used to formally declare that you have been a victim of identity theft. It often includes details about the fraudulent activities and can help in disputing unauthorized transactions or accounts opened in your name.
  • Fraud Alert Request: By submitting this request to credit bureaus, you can place a fraud alert on your credit report. This alerts creditors to take extra steps to verify your identity before opening new accounts, helping to prevent further fraud.
  • Credit Report Request: Victims of identity theft are entitled to request a free credit report from the major credit bureaus. This report allows you to review your credit history for any unauthorized accounts or transactions.
  • Dispute Letter: If you find unauthorized accounts or transactions on your credit report, a dispute letter can be sent to the creditors or credit bureaus. This letter formally disputes the inaccuracies and requests their removal from your credit history.
  • Identity Theft Recovery Plan: This plan outlines the steps you need to take to recover from identity theft. It includes contacting financial institutions, monitoring accounts, and possibly working with a credit counseling service.

Each of these documents plays a crucial role in the process of recovering from identity theft. They not only support your claim but also help protect your identity moving forward. Ensure that you keep copies of all documents for your records and follow up on any necessary actions as recommended.

Similar forms

The Colorado DR 2153 form is similar to the Identity Theft Affidavit used by the Federal Trade Commission (FTC). This document allows individuals to report identity theft and provides a structured way to inform creditors about fraudulent accounts. Both forms require personal information and details about the theft. They also emphasize the importance of providing accurate information to avoid legal repercussions. Like the DR 2153, the FTC affidavit serves as an official declaration to assist in the recovery process.

Another document comparable to the Colorado DR 2153 is the Identity Theft Report from the local police department. This report is essential for victims to establish a record of the crime. It often includes similar information about the victim's identity and the circumstances surrounding the theft. Both documents require the victim's signature and can be used to dispute fraudulent charges or accounts. The police report is often a necessary attachment when submitting the DR 2153 form.

The IRS Identity Theft Affidavit (Form 14039) is also akin to the Colorado DR 2153. This form is specifically designed for taxpayers who believe their tax-related information has been compromised. Both forms require personal identification details and a declaration of unauthorized use of personal information. The IRS affidavit aims to protect the victim from tax fraud, while the DR 2153 focuses on obtaining a new driver’s license or ID number.

Similarly, the Social Security Administration (SSA) Identity Theft Report serves a parallel purpose. Victims of identity theft can use this report to alert the SSA about fraudulent use of their Social Security number. Both the SSA report and the DR 2153 require detailed accounts of the theft and may necessitate police reports. They aim to protect the victim's identity and prevent further misuse of their personal information.

The Credit Reporting Agency's Fraud Alert is another document that aligns with the Colorado DR 2153. This alert notifies credit bureaus to take extra steps to verify the identity of anyone applying for credit under the victim's name. Both documents emphasize the importance of protecting personal information and require the victim to provide specific details about the identity theft incident. The alert can help prevent further fraudulent activities while the DR 2153 helps in securing a new driver's license.

The Medical Identity Theft Affidavit is also comparable. This form is used when someone’s medical information is misused, leading to fraudulent medical claims. Both the medical affidavit and the DR 2153 require a declaration of unauthorized use of personal information. They serve to protect the victim's rights and assist in rectifying the consequences of identity theft.

Additionally, the Department of Motor Vehicles (DMV) Identity Theft Form in various states shares similarities with the Colorado DR 2153. This form allows individuals to report identity theft specifically related to their driver’s license or ID card. Both documents require personal information and details about the theft. They aim to ensure that the victim can obtain a new ID while addressing the fraudulent use of their original identification.

The Victim Impact Statement is another document that can be related to the DR 2153. While this statement is often used in criminal cases to outline the emotional and financial effects of a crime on the victim, it can also support identity theft claims. Both documents highlight the consequences of identity theft and may be used in legal proceedings to establish the impact on the victim.

Lastly, the State Attorney General’s Identity Theft Complaint Form is similar in its purpose. This form allows victims to report identity theft to the state attorney general's office. Both the complaint form and the DR 2153 require detailed personal information and specifics about the theft. They serve as official records that can aid in the investigation and resolution of identity theft cases.

Dos and Don'ts

When filling out the Colorado DR 2153 form, it’s important to approach the process with care. Here are four key things to keep in mind:

  • Do ensure all information is accurate. Double-check your full legal name, date of birth, and social security number. Mistakes can lead to delays or complications.
  • Don't submit false information. Knowingly providing incorrect details can lead to serious legal consequences, including charges of perjury.
  • Do attach necessary documentation. Include a copy of the police report and any other supporting documents. This will help validate your claim.
  • Don't forget to notarize the form. A notarized signature is required before submitting the form to ensure its authenticity.

By following these guidelines, you can navigate the process more smoothly and help protect your identity effectively.

Misconceptions

Misunderstandings about the Colorado DR 2153 form can create unnecessary confusion for those who need to report identity theft. Here are some common misconceptions:

  • It is not necessary to file a police report. Many believe that they can submit the DR 2153 form without a police report. However, the form explicitly requires a police report to be attached when applying for a new driver's license or ID.
  • Anyone can fill out the form on behalf of the victim. Some think that friends or family can complete the form for the victim. In reality, only the individual whose identity was stolen can legally fill out and sign the affidavit.
  • The form can be mailed or faxed to the DMV. There is a misconception that the completed form can be sent through mail or fax. It must be taken in person to a driver’s license office, as specified in the instructions.
  • Submitting false information is a minor issue. Some individuals underestimate the seriousness of providing false information. Knowingly submitting inaccurate details can lead to criminal prosecution for perjury.
  • The affidavit guarantees a new driver's license or ID. While the form is a necessary step, it does not automatically ensure that a new license or ID will be issued. The DMV will review the information and may take additional steps before making a decision.
  • All identity theft cases are the same. Many believe that all identity theft situations are identical. Each case is unique, and the specific details surrounding the theft can significantly impact the process and outcome.
  • There is no time limit for filing the affidavit. Some individuals think they can wait indefinitely to report identity theft. It is advisable to act quickly, as delays can complicate the resolution process.
  • Only financial information is relevant. Many assume that only financial details are pertinent to identity theft. However, any personal information, such as Social Security numbers or identification documents, can be exploited by identity thieves.
  • The affidavit is the only step needed to resolve identity theft. Some believe that completing the DR 2153 form is the final step. In reality, victims may need to take additional actions, such as monitoring their credit or contacting financial institutions.

Understanding these misconceptions can empower individuals to take the correct steps when dealing with identity theft. It is crucial to approach the process with accurate information and a clear understanding of the requirements involved.

Key takeaways

When dealing with identity theft, filling out the Colorado DR 2153 form is a crucial step. Here are some key takeaways to keep in mind:

  • Submit in Person: Do not mail or fax the completed form. Instead, take it to a driver’s license office along with a police report.
  • Notarization Required: Ensure the form is notarized before submission. This adds a layer of authenticity to your claim.
  • Accurate Information: Fill in your full legal name and any other names you may have used. Accuracy is essential to avoid complications.
  • Document the Fraud: Clearly describe how the fraud occurred. This includes checking the appropriate boxes and providing additional comments if necessary.
  • Law Enforcement Actions: Indicate whether you reported the incident to the police. Include details about the report and the agency involved.
  • Penalties for False Information: Be aware that providing false information can lead to serious consequences, including criminal prosecution for perjury.

By following these guidelines, you can effectively navigate the process of addressing identity theft in Colorado.