Fillable Printable Lt-176
Fillable Printable Lt-176
Lt-176
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NOTE TO OFFICER: Provide completed form to DCI terminal operator so that seizure information can
be sent to DMV via DCI Formatted Screen within 24 hours of seizure. DCI terminal operator should
keep this form on file for one week after entry. You may call (919) 861-3185 for assistance.
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(Add Additional Pages If Necessary)
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INSURANCE INFORMATION FOR OTHER VEHICLE(S) INVOLVED
NOTE: Complete This Section For All Other Vehicles Involved
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INSURANCE INFORMATION
NOTE: Complete This Section If Seized Vehicle Is Damaged
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