Mac, Redmond, Rudy Towing

PO Box 584

Kirkland, WA 98083-0584

AUTHORIZATION TO IMPOUND VEHICLE

THE UNDERSIGNED PERSON, HAVING AUTHORITY TO IMPOUND HEREBY AUTHORIZES Mac Towing (Shannon-Thorpe Corp.) TO IMPOUND THE VEHICLE DESCRIBED BELOW FROM,

ADDRESS: ____________________________________________________________

THIS __________ DAY OF _____________, _______ AT _______________AM/PM

BECAUSE SUCH VEHICLE IS A VEHICLE SUBJECT TO IMPOUND WITHIN THE MEANING OF RCW CHAPTER 46.55.010(012)

A PERSON AUTHORIZING THIS IMPOUND, IF THE IMPOUND IS FOUND IN VIOLATION OF CHAPTER 46.55, MAY BE HELD LIABLE FOR THE COSTS INCURRED BY THE VEHICLE OWNER.

THIS VEHICLE TO BE IMPOUNDED IS DESCRIBED AS FOLLOWS:

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YEAR LICENSE# MAKE/MODEL VIN#

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AUTHORIZED SIGNATURE

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PLEASE PRINT YOUR NAME

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Washington Driver License #

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AGENCY REPRESENTED

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TITLE

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PHONE NUMBER

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REASON FOR IMPOUND

(425) 883-2800 (425) 822-2800 (425) 485-2800

www.mactowing.com

Fax # (425) 881-2812