usm623 TOW TICKET.pdf
PDF 575 KB Posted
- Attached to
- Vehicle Services for E & W/VA and D/DC
- Solicitation number
- 15M10220QA4100006
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Text version
Form USM-623 Rev. 11/14
Contractor Driver's Name: Gov't Officer Who Ordered Tow:
Date and Time of Pickup:Location of Pickup:
Date and Time of Delivery:Location of Delivery:
Asset ID # (CATS ID):District Office: Vehicle Year:
Color:Model (including XL, XLT, LS, etc.):Make:
License Plate #:VIN: Operable? Keys?Yes No Yes No
State of Registration:Model of Tires:Make of Tires:
Yes NoHidden Compartment? If yes, location:
Towing Rate:Current Vehicle Mileage:
End of Tow:Odometer readings of tow truck/carrier - Beginning of Tow: Total Miles:
INTERIOR CONDITION
Front Carpet
Rear Carpet
Front Seat
Rear Seat
Door Panels
Trunk
Headliner
StainedTornGood
Good StainedTorn
StainedTornGood
StainedTornGood
StainedTornGood
Dash
TRANSMISSION
ENGINE # of Cylinders:
POWER
STEERING
DOORS
SEATS
ROOF
STEREO
OPTIONS
WHEELS
4-Wheel DriveManualAutomatic
Diesel
CruiseTelescopicTiltPower A/C: Yes No
Hatchback432 Other:
Other:BrakesDoor LocksSeatsWindows
Other:
ClothVinylLeather3rd SeatBenchBucket
Convertible CanvasVinylPower SunroofT-TopHardtop
AM/FM Radio CD CD Changer Tape Player
Factory Stereo Brand: No Stereo Custom Stereo Other:
Navigation Heated Seats Alarm System TV DVD
Customized Rims
Custom WheelsFactory WheelsSpoke WheelsHubcaps
EXTERIOR CONDITION IDENTIFICATION CODES
D = Dented CR = Cracked S = Scratch FT = Flat Tire M = Missing BE = Bent L = Loose C = Cut PC = Paint Chip R = Rust DR = Damaged Rim B = Broken
U.S. Department of Justice United States Marshals Service Asset Forfeiture Division - Standard Tow Ticket
INSTRUCTIONS: This form is to be utilized by the contractor or District Office only when a vehicle is towed to the contractor facility. A copy of this form should be placed in the case file.
Comments/Additional Notes:
Yes NoSpecialty Rims? If yes, make and model:
Electric CNG
Form USM-623 Rev. 11/14 ..\VehicleDiagram.jpg Operable?
Keys?
Hidden Compartment?
INTERIOR CONDITION
Front Carpet
Rear Carpet
Front Seat
Rear Seat
Door Panels
Trunk
Headliner
Dash
TRANSMISSION
ENGINE # of Cylinders:
POWER
STEERING
DOORS
SEATS
ROOF
STEREO
OPTIONS
WHEELS
A/C:
EXTERIOR CONDITION IDENTIFICATION CODES
D = Dented CR = Cracked S = Scratch FT = Flat Tire M = Missing BE = Bent L = Loose C = Cut PC = Paint Chip R = Rust DR = Damaged Rim B = Broken U.S. Department of Justice United States Marshals Service Asset Forfeiture Division - Standard Tow Ticket INSTRUCTIONS: This form is to be utilized by the contractor or District Office only when a vehicle is towed to the contractor facility. A copy of this form should be placed in the case file.
Specialty Rims?
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