DR 0201 (08/30/13) 
COLORADO DEPARTMENT OF REVENUE                                                      *140201==19999*
Denver, CO  80261-0009

                                        Overweight Vehicle Refund

Who qualifies:                                             Section 3:
Individuals or businesses who purchase a new 2010 or       Sign and date the application, print the signer's name.  
later vehicle with a GVW in excess of fifty-four thousand  Include job title when the refund is requested by a  
pounds (54,000) on or after July 1, 2011, and use this     business.  
vehicle in interstate commerce.                            The application must be accompanied by proof of  
Complete all applicable items in each section.             payment of Colorado state sales and/or use taxes  
Section 1:                                                 paid by the taxpayer associated purchase. Applications  
                                                           without the requested documentation will not be  
Enter owner's name or business name, Colorado IRP          processed. Documentation includes: 
account number, social security number, or federal ID 
number home or business address, and mailing address,              A copy of the purchase/lease agreement showing 
if different from street address.                                  Colorado sales tax collected. 
Section 2:                                                         Colorado vehicle registration showing sales tax  
                                                                   collected. 
Line 1: Enter make, model, year, vehicle identification 
number (VIN), and date of purchase for the vehicle which   Refunds are processed on a first-in first-out basis.  
you are requesting the refund.                             Refunds will be issued until available allocated  
                                                           funds expire. 
Line 2: Enter Colorado sales tax paid, purchase price, 
mark if you purchased or leased the vehicle and the  
number of month of the lease when applicable. Only the 
2.9% state sales tax is refundable, no local taxes are to 
be included in your request. If the refund is being  
requested on a leased vehicle include only state  
sales taxes paid during the calendar year   
Last Name                               First Name                              Middle Initial Colorado IRP Number

Address                                            City                                          State Zip

Mailing Address                                    City                                          State Zip

Phone Number                                               Fax Number
(        )                                                 (          )
Vehicle Information: This motor vehicle must be titled and registered in the State of Colorado. Attach a copy of the 
Colorado title and a copy of the Colorado registration.
Make                                    Model                                   VIN                          Year (YYYY)

Date of Purchase (MM/DD/YY) Colorado Sales Tax Paid        Purchase Price           Purchase Date (MM/DD/YY)

Lease Number                                               Months

Applicant Certification: I certify under penalty of perjury in the second degree that the above statements are true  
correct and complete.
Signature of Owner or Corporate Officer                                             Date (MM/DD/YY)

Name (please print)                                        Title (if applicable)