You have requested to obtain a Motor Vehicle Report

(driving record) for the
STATE OF COLORADO

Step 1. Please print this out

Step 2. Fill out the form (leave requestor's info blank)

Step 3. HAVE THE APPLICANT SIGN AND DATE the form

Step 4. Fax the completed form to I-NEX Solutions, Inc. at

fax (813) 968-2195

Step 5. The records can NOT be searched until the release form is received by I-NEX.

Form on next page

COLORADO

Permission for Release of Records

Record information available at Drivers License offices and 1881 Pierce st.
All others requests available only at 1881 Pierce St. Lakewood, Co.

I hereby authorize the release of records maintained by the Colorado Department of Revenue, Motor Vehicle Division Pursuant to the Driver’s Privacy Protection Act (18 USC 2721) and Colorado law (42-72-204, 42-1-206, 42-3-125 CRS).

Printed Name_____________________________________________________________

Signature________________________________________________________________

Date of Birth__________________License number______________________________

Purpose for which records are released________________________________________

_______________________________________________________________________

Requestor’s Name_________________________________________________________

Company________________________________________________________________

Address_________________________________________________________________

City_________________________State________________Zip code________________

Signature of Requestor_____________________________Date____________________

Leave requestor’s info box blank