USM-623.pdf

Form USM-623 Rev. 10/14

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:

Form USM-623 Rev. 10/14 ..\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?