DR 0070 (10/02/12) 
COLORADO DEPARTMENT OF REVENUE 
Taxpayer Service Division 
1375 Sherman Street 
Denver, CO  80261 
www.colorado.gov/revenue

                          Statement of Purchase Price of Motor Vehicle

Name of Purchaser

Address                                                                            Phone 
                                                                                   (        )
City                                                                               State           ZIP

Make of Vehicle                                                                    Year

Body Type                                                                          Vehicle Identification Number (VIN)

Purchase Price                                                                     Date of Purchase

Purchase price means the price to the consumer. Reference  §39-26-102(7)(a), C.R.S.

                               Purchased From
Name

Address                                                                            Phone 
                                                                                   (         )
City                                                                               State           ZIP

I declare, under penalties of perjury in the second degree, that the purchase price noted above was the total price paid by 
me for the above vehicle and that there were no other considerations in this matter. I further understand that the Colorado 
Department of Revenue is authorized to make further inquiries from the selling party and others as to the selling price.
Purchaser's Signature                                                              Date