FRONT REAR TOP 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

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FRONT REARTOP

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 itis 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 items1. Fenders2. Hood and grill3. Windshield/Glass4. Lights/Lenses5. Top6. Sides7. Trunk8. Bumpers9. Doors

10. Tires/Rims11. Other

Vehicle inventory: Check Yes or No as applicableYes No

1. Trunk locked2. Glovebox locked3. Spare tire4. Car stereo5. Speakers6. Keys7. Tapes/Compact discs8. CB radio9. Car phone

10. Jack11. Tire chains

Additional items:

DLR-430-507 (R/8/13)WA

ORIGINAL - TOW COMPANY COPY - CUSTOMER