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2. Annual Renewal and Disclaimer

   You will be notified annually to confirm that you still qualify and/or still own the subject property.

   Disclaimer:

   Interested parties (banks, title companies, etc.) will still have access to unredacted documents in person.

4. Email*
5. Phone Number*
7. First Name*
8. Last Name*
10. Complete address and legal description of property*

    Enter N/A if no property is owned

12. Type of Protected Person

    Please indicate the type of Protected Person you are applying as below. You must answer affirmatively in at least one of the numbered categories. Please note: you must reapply annually to continue to be blocked.

    Link to Title 18 of the Colorado Revised Statutes.

    Link to Title 24 of the Colorado Revised Statutes.

14. 1. A participant in the Address Confidentiality Program, as defined by C.R.S. 18-9-313 and 24-30-2101, with a valid Address Confidentiality Program authorization card.

    1. Yes
16. 2. A Protected Person pursuant to C.R.S. 18-9-313, specifically;

    1. Human Services Worker
    2. Educator
    3. Judge
    4. Peace Officer
    5. Prosecutor
    6. Public Defender
    7. Public Health Worker
    8. Public Safety Worker
    9. Code Enforcement Officer
    10. Child Representative
    11. Animal Control Office
    12. Health Care Worker
    13. Office or Agent of the State Bureau of Animal Protection
    14. An Office of the Respondent Parent's Counsel Staff Member or Contractor
18. 3. An Election Official pursuant to C.R.S 18-9-313.5

    1. Yes
20. 4. An immediate family member of a Protected Person. Pursuant to C.R.S. 18-9-313, immediate family means a Protected Person's spouse, child or parent or any other blood relative who lives in the same residence as the Protected Person.

    1. Yes
22. 5. An immediate family member of an Election Official. Pursuant to C.R.S. 18-9-313.5, immediate family means an Election Official's spouse, child, or parent or any other person who lives in the same residence as the Election Official.

    1. Yes
24. Please provide a list of Reception numbers you want blocked.
26. Please provide a list of Assessor schedule numbers/parcel numbers you want blocked.
28. Please provide a list of Treasurer account numbers you want blocked.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field