Fillable Printable Authorization To Impound/Tow And Vehicle Inventory
Fillable Printable Authorization To Impound/Tow And Vehicle Inventory
Authorization To Impound/Tow And Vehicle Inventory
FRONT
REARTOP
X
X
Authorization to Impound / Tow and Vehicle Inventory
License number State VIN (Vehicle Identification Number) Make Model Year
I hereby authorize
Towing firm
to impound or tow this vehicle from
Location
this date of at (time) a.m. p.m because it
is an unauthorized vehicle within the meaning of RCW 46.55.010(14).
A person or agency authorizing this impound, if the impound is found in violation of chapter 46.55 RCW, may be held
liable for the costs incurred by the vehicle owner.
Print name Title
Name of authorizing individual
Signature WDL #
Signature of authorizing individual Washington driver license number
Mailing address
Date of impound Time of impound a.m. p.m.
Individual/agency authorizing this impound: Private property owner* Private property custodian*
Law enforcement Other public official
*This vehicle is of scrap value and I agree to pay the above named towing firm $ to impound this vehicle.
Signature of tow driver Unit number
Body condition: Shade damaged areas and check applicable items
1. Fenders
2. Hood and grill
3. Windshield/Glass
4. Lights/Lenses
5. Top
6. Sides
7. Trunk
8. Bumpers
9. Doors
10. Tires/Rims
11. Other
Vehicle inventory: Check Yes or No as applicable
Yes No
1. Trunk locked
2. Glovebox locked
3. Spare tire
4. Car stereo
5. Speakers
6. Keys
7. Tapes/Compact discs
8. CB radio
9. Car phone
10. Jack
11. Tire chains
Additional items:
DLR-430-507 (R/8/13)WA
ORIGINAL - TOW COMPANY COPY - CUSTOMER
Click here to START or CLEAR, then hit the TAB button
Authorizing individual: When completed and printed, sign here.
Tow driver: When completed and printed, sign here.
