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Roadside Memorial Sign Application
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Return to Roadside Memorial Signs Page
Link to page
Mail-in PDF Application Form
Link to PDF application form
If you would prefer to mail the application, please complete, print, and sign the PDF version. Mail the application with supporting documents to Transportation and Engineering, 100 Jefferson County Parkway, Suite 3500, Golden, CO 80419.
Name of person or group applying for sign
Address Line 2
Date of fatal crash
Date of fatal crash
Location of crash
Investigating law enforcement agency
Name of the driver on the crash report
Crash Report Number
If you have a copy of the crash report, you may upload it here.
Victim's name as it appears on the crash report
Second victim's name as it appears on the crash report (if applicable)
Third victim's name as it appears on the crash report (if applicable)
Signs can be selected from the following:
Select Roadside Memorial Sign Message
Please choose one.
DON'T DRINK AND DRIVE (note specific requirements below)
PLEASE DRIVE SAFELY (for any fatalities)
PLEASE RIDE SAFELY (for motorcycle / bicycle fatalities)
PLEASE BUCKLE UP (for fatalities where victim was not wearing a seat belt)
Requirements for DUI related crashes:
Signs titled "DON'T DRINK AND DRIVE" are for Driving Under the Influence (DUI) related crashes where the driver was convicted of violating Colorado DUI laws. Memorial signs will not be erected for deceased drivers involved in fatal crashes whose toxicology reports show a violation of Colorado DUI laws without written consent from any other victim(s) or their immediate families.
Permission to install DON'T DRINK AND DRIVE sign
Written consent from any other victim(s) or their immediate families may be uploaded here.
Each sign will be accompanied by an IN MEMORY OF sign. A maximum of three names may be placed on a sign.
Victim's name as it should appear on the sign
Second victim's name as it should appear on the sign (if applicable)
Third victim's name as it should appear on the sign (if applicable)
Jefferson County, Colorado and the applicant agree to and approve the use of electronic signatures for purposes of this application. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act, C.R.S. §§24‐71.3‐101 to ‐121.
Do you agree to the above acknowledgment?
Relation to Victim
If the applicant is not an immediate family member of the victim, write "Sponsor" and attach written consent from an immediate family member, listing their relationship to the victim, naming the applicant as an authorized representative, and indicating who should be contacted when the sign is removed.
Written consent from the victim's family
If you are a sponsor, you may upload written consent from the victim's immediate family here.
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