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2. Applicants must meet the following criteria to be eligible for selection:
   • Be a Colorado Resident throughout the process.  Applicants changing residency to or moving out-of-state at any point in the process agree their application will be rescinded and any awarded funds will be forfeited.
   • Be the current registered owner of a vehicle titled and registered through the Colorado Department of Revenue that has been stolen out of OR recovered in Fort Lupton, Lochbuie, Commerce City, or Brighton, Colorado. The loss cannot have occurred prior to July 1, 2024.
   • Filed and obtained a police report regarding the theft of stolen vehicle or catalytic converter(s) for the above-listed vehicle.
   • Had at least the minimum Colorado liability insurance in place for the above-listed vehicle at the time of loss.
   • Provide proof of cost for all associated costs and completed repairs or services via receipts or invoices that include the Vehicle Identification Number (VIN) and applicable part numbers.
4. Please also note:

   Profiting or in any way being involved in illegal activity associated with the theft of the vehicle listed above may reduce an amount an applicant is selected to receive, may prevent an applicant from being selected to receive funds and may result in further investigation and/or charges being filed in association to the illegal activity.

   Applicants must complete the following application in its entirety to qualify for assistance, but completing an application does not guarantee that the applicant will be selected to receive assistance in any amount.

   
   

   Any work or repairs completed must be completed with a business registered with the Colorado Secretary of State to be eligible for payment or reimbursement.

   
   

   Victims may reach out for assistance in completing this application with a member of the Brighton Office for Victim Assistance by calling 303-655-2308.
   
   

   If any funding is provided by this program that is subsequently also paid by another source, including the victim's insurance, the victim will be required to reimburse or forward the funds to the State Of Colorado.
6. You will want to have the following items from the person needing assistance available or downloaded before you begin:
   • A single file of an image or scan of both the Colorado driver's license and the valid Colorado vehicle registration of the vehicle that was subject to itself being stolen that can be uploaded from this device. Registration that was expired or invalid at the time of loss may not be considered.
   • A single file image or scan of the insurance declaration page(s) in effect at the time of loss showing all pertinent vehicle information and coverages.  Insurance cards (the cards normally kept in vehicles) will not be accepted.
   • A single file of a scan or image showing all pages of the police report corresponding to the vehicle being stolen or of the theft of its catalytic converter.
8. Assistance Category*

   Assistance may only be provided for costs directly associated with the theft or documented attempted theft of a motor vehicle. What forms of assistance are you requesting (select all that apply)?

   1. Temporary transportation assistance
   2. Tow or impound services
   3. Cleaning services
   4. Stipend to help offset an insurance deductible
   5. Reimbursement for minor vehicle repairs resulting from a vehicle theft
   6. Outstanding loan assistance from a stolen vehicle
   7. Aftermarket vehicle theft prevention devices
10. Assistance Request*

    This program is intended to help assist underserved Colorado citizens. Please explain thoroughly the circumstances of your loss and what type of assistance you are requesting.  Please understand that funds are limited and submission of an application does not guarantee an offer of assistance in any amount.

12. Assistance Amount*

    Please estimate the amount you are requesting to support your victimization from the theft of a motor vehicle.

14. Victim Information

    Applicants must complete all questions in their entirety and supply supporting documentation when requested.  Applications or attachments that are incomplete, illegible, cut off, corrupted or undiscernible may not be considered.

16. First Name*
17. Last Name*
19. Address1*
21. Address2
23. City*
24. State*
25. Zip*
27. Phone Number*
29. Owner at time of loss?*

    Were you the owner of a vehicle which was subject to itself being stolen since July 1, 2024? And was the vehicle a Colorado registered vehicle that you owned, had registered in Colorado, and had insured at the time of loss? You will be asked to provide supporting documentation later in this document.

    1. Yes
    2. No
31. Still owner?*

    Do you still own, register in Colorado, and insure the same vehicle upon which was subject to itself being stolen? You will be asked to provide supporting documentation later in this document.

    1. Yes
    2. No
33. Applied before?*

    Have you applied to receive assistance for victim support of Motor Vehicle Theft?

    1. Yes
    2. No
35. Vehicle Information

    Please enter all information corresponding to the stolen vehicle:

37. VIN*
38. Vehicle Make*
40. Vehicle Model*
41. Vehicle Model Year*
43. License Plate*
45. Registration Upload*

    Upload a copy of your current registration, this file can be a photo, a scan, or a document. Uploads that are incomplete or for which the images are cut off may prevent you from receiving assistance.

47. Insurance Information

    Please complete the insurance information for your vehicle that was subject to the theft.

49. Insured?*

    Was your vehicle insured at the time of the loss?

    1. Yes
    2. No
50. Insurance Agency*
52. Insurance Policy Number*
53. Insurance Expiration Date*
55. Insurance Phone Number*
56. Insurance Claim Filed?*

    Did you file a claim with your insurance for the loss of this vehicle?

    1. Yes
    2. No
58. Insurance Coverage*

    What type of insurance coverage do you have for the above listed vehicle?

    1. Liability only
    2. Comprehensive Coverage for the loss
    3. Comprehensive Coverage with Gap insurance for the loss
    4. No insurance
60. Deductible

    What is the deductible for the covered vehicle that was stolen?

    (Skip this question if you answered "Liability Only" on the previous question.)
61. Total Loss?*

    Did your insurance company consider your claim a total loss?

    1. Yes
    2. No
    3. I did not file a claim
63. Insurance Upload

    Upload a copy of the title page on your insurance policy.  It must show the matching vehicle description, effective dates, and coverages indicated on this application.  This form is usually a full-page size, not the pocket card that you carry in your vehicle.  

65. Police Report

    Please complete all information relating to police report involving the theft.

67. Date of theft*

    What was the date of theft for the vehicle? If unknown, what was the date you discovered the theft of your vehicle?

68. Law Enforcement Agency*

    With what law enforcement agency did you file the police report regarding the theft of your vehicle or its catalytic converter?

70. Case Number*

    Enter the corresponding case number issued by the law enforcement agency.

71. Police Report Upload

    Upload a copy of the police report corresponding to the theft.

73. Services Rendered:*

    Have you already paid for repairs, replacements or services related to this loss?

    1. Yes
    2. No
74. Payments Received*

    Have you received any reimbursements to help offset any costs associated with the loss sustained to your vehicle?

    1. Yes
    2. No
76. Receipt Upload

    Please upload any receipts for any services to your vehicle which have already been rendered.

Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field