10._TOW_TICKET.pdf

Form USM-623 Rev. 10/11

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

Good Torn Stained

Good Torn Stained

Good Torn Stained

Good Torn Stained

Good Torn Stained

Dash

TRANSMISSION

ENGINE # of Cylinders:

POWER

STEERING

DOORS

SEATS

ROOF

STEREO

OPTIONS

WHEELS

Automatic Manual 4-Wheel Drive

Diesel

Power Tilt Telescopic Cruise A/C: Yes No

2 3 4 Hatchback Other:

Other:BrakesDoor LocksSeatsWindows

Bucket Bench 3rd Seat Leather Vinyl Cloth

Other:

Hardtop T-Top Power Sunroof Vinyl Canvas Convertible

AM/FM Radio CD CD Changer Tape Player

Custom Stereo No StereoFactory Stereo Brand:

Other:

Navigation Heated Seats Alarm System TV

Customized Rims

DVD

Hubcaps Spoke Wheels Factory Wheels Custom Wheels

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. 10/11 ..\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?