Affidavit of Heavy Vehicle Use Fleet #___________if applicable

Unit #___________

Phone: 720-.523-6010 Mailing: Adams County Motor Vehicle P.O. Box 5011 4430 S Adams County Pkwy Suite E2001 Brighton, CO 80601 Brighton, CO 80601-8215 Rev. 02/11/2021

This document is required on all initial registrations or changing/updating information on an existing registration on all Semi-Tractors and all Trucks with an empty weight in excess of 10,001 lbs.

Year___________Make_____________________________VIN_______________________________________________

***Required***My Declared GVW is __________________ lbs.

How do I calculate the GVW?

The empty weight (lbs.) of my Truck/Tractor ___________________

The empty weight (lbs.) of my Trailer (if any)___________________

The highest weight (lbs.) of any load carried ___________________

Total equals the GVW= ____________________

If the Declared GVW is 55,000 or greater, proof of payment or waiver on IRS Form 2290 is required on all below registration types:

• GVW/TVW/SVW• Public Utility Company Utility Trucks• Farm Trucks/Tractors• Recreational/Non-Commercial vehicles

Business Use of the Vehicle (select one) Complete if applying for or renewing TVW, SVW & SMM over 2,500 miles.

I am a Common/Contract Carrier (More than 51% of the time I haul a cargo that I do not own, or I charge for delivery).

I am a Private Carrier (More than 51% of the time I haul a cargo that I own and do not charge for delivery).

Mileage traveled last year was _____________. Initial registration must have proof of vehicle replacement if less than 10,000.

This vehicle is never used commercially. DR 2696 Non-Commercial vehicle affidavit is required.

I own or am the agent for a farm/ranch and this vehicle is only used commercially to transport Farm/Ranch supplies/goods to and/or from the market. DR 2159 Farm Vehicle Registration Affidavit is required.

I am the agent of a Public Utility Company and this vehicle is a Utility Truck weighing in excess of 10,001 pounds with equipment mounted to maintain the utilities.

This vehicle is a Special Use Truck as defined by statute or rule of the following type (Select One):

Concrete Mixer or Concrete Pumper Blood Mobile or Medical Testing Truck

Trash Compactor or Roll-off Trash Truck Truck for Towing, Wrecking or Repairing

Recycled Materials Truck or Roll-off Mobile Veterinary Truck

Beverage Canister & Deliver Trucks with roll up sides

I declare under penalty of perjury in the second degree that the above statements are true and correct to the best of my knowledge.

Name_____________________________ Signature _______________________________ Date __________________