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X Certificate of Fact Use this form to make a statement of fact License plate/Registration number Vehicle Identification Number (VIN) or Hull Identification Number (HIN)

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Form Approved for Optional Use Judicial Council of California MC-031 [Rev July 1, 2005] ATTACHED DECLARATION PLAINTIFF/PETITIONER: CASE NUMBER:

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DR 2444 (05/13/08) COLORADO DEPARTMENT OF REVENUE DIVISION OF

Signature Date I certify, under penalty of perjury in the second degree, that the above facts are true and correct to the best of my knowledge Name