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RESTRICTED LICENSE AFFIDAVIT OF NON-OWNERSHIP

DR 2056 (08/04/05). COLORADO DEPARTMENT OF REVENUE. DIVISION OF MOTOR VEHICLES. DRIVER CONTROL SECTION. RESTRICTED LICENSE . AFFIDAVIT OF NON-OWNERSHIP . Name CO PIN. Address City State ZIP. As a condition of my reinstatement, pursuant to , I hereby certify that: 1. I am not the registered owner or co-owner of any motor vehicle registered or plated in the State of Colorado. 2. I have no access to any motor vehicle in which to install an approved ignition interlock device. 3. If, following the issuance of a RESTRICTED LICENSE /permit under the above referenced title, I should become the owner or co- owner of any motor vehicle, or otherwise obtain access to any motor vehicle in which an approved ignition interlock device may be installed, I shall submit to the Department an AFFIDAVIT and signed lease agreement for the installation and use of such device for a period equal to the remaining period of the RESTRICTED LICENSE .

installation and use of an approved ignition interlock device on such vehicle(s), for a period equal to the remaining period of the restricted (ignition interlock) license. Your period of license restriction (ignition interlock) may be extended: Data from your interlock device will be collected and forwarded to Driver Control regularly.

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  Approved, Ignition, Interlock, Ignition interlock, Approved ignition interlock

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