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Representative Operator

Location:
Hatfield, PA, 19440
Posted:
December 26, 2018

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Resume:

AUTHORIZATION TO RELEASE/VIEW AUTOMOBILE

(circle release or view)

NO FAXES OR CORRECTIONS

TO: Chief of Police, City of Dallas, Texas

You are hereby authorized to release a (make) (model), License Plate, State, year, VIN, impounded on (date) / / owned and/or operated by the undersigned, which is now being held in the City of Dallas Police Pound to .

(Person and/or Company Property being released to) I have duly authorized the above named party as my representative to take possession of/view the said automobile and to pay any charges or fees for towage, storage, impoundment, or notification accruing on said automobile. The above named representative may also take possession of any property removed from this automobile and stored at the Automobile Pound.

EXECUTED AT, this is the day of, A.D. 20 . Signature of Owner or Authorized Representative Company Name/Position of the Person Signing Printed Name Address

Telephone Number

THE STATE OF COUNTY OF BEFORE ME, the undersigned authority, personally appeared and stated to

(Owner/Rep printed name)

me, under oath, that (HE) (SHE) is the owner and/or operator of the above described automobile stored at the Dallas Police Automobile Pound.

GIVEN UNDER MY HAND AND SEAL OF OFFICE,

this the day of, A.D. 20 .

NOTARY PUBLIC SIGNATURE

Notary Public in and for County, State In consideration for the release of the referenced property, the undersigned releases the City of Dallas, the Police Department and the employees of the City of Dallas, from any and all liability, claims, suits, demands or cause of actions, which may arise out of or be brought against the City of Dallas, it Police Department or the employees of the City of Dallas by virtue of the delivery of the above property to me. NOTE: THE LICENSE PLATE NUMBER AND THE CORRECT VEHICLE IDENTIFICATION NUMBER MUST BE SHOWN INVENTORY CONTROL NUMBER (if known)



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