DCMV 401 4/4/2018

Request to Cancel Colorado License Plates

I/We, ______, request that the following Colorado License Plate/Record be cancelled:

Plate type: ______and Plate number: ______This plate is currently registered to the following vehicle: Year ______Make ______VIN ______

By canceling, I/We acknowledge that any remaining credit from this record is hereby forfeited.

Plates received by county office: Yes ______No ______If above is checked no please explain: ______

I certify, under penalty of perjury in the second degree, that the above information is true and accurate to the best of my knowledge.

Owner 1 Printed Name as it appears on Identification: ______Owner Signature: ______Date: ______

Owner 2 Printed Name as it appears on Identification: ______Owner Signature: ______Date: ______

Owner 3 Printed Name as it appears on Identification: ______Owner Signature: ______Date: ______

Owner 4 Printed Name as it appears on Identification: ______Owner Signature: ______Date: ______