1)

I,

, am the owner or owner's agent (spouse, child,

brother, sister, parent, attorney or court appointed legal representative ONLY may be considered to be owner's agent) of the following vehicle:

2)

Make

Model

Year

VIN #

License Plate # (Include State)

3)

My address is:

Street

City

State

Zip Code

4)

This authorization is hereby given to

of

, to tow the vehicle described above.

5)

I hereby state and affirm, under oath, that I am the duly authorized owner or owner's agent

of the vehicle described above.

Date:

Signature:

Instructions – Written Authorization to Tow Form

All parts of this form must be legible, in ink or typewritten, and completely filled out.

Line 1 – Fill in your complete name. Note that only certain persons may qualify as owner's agent.

Line 2 – Give make, model and year of vehicle being towed. Also include VIN (Vehicle Identification Number) number and license plate number (including state).

Line 3 – Provide your complete mailing address.

Line 4 – Fill in full name of person towing the vehicle and complete mailing address.

Line 5 – Sign in ink and date. Note that the permission you provide in this form is under oath.

Special Note: Other State and local requirements concerning proof of ownership and identification of owner or owner's agent may have to be met before the vehicle may be released.