APPLICATION FOR ABANDONED MOTOR VEHICLE _____________________________________________________ Your Full Name _____________________________________________________ If Agent for a Corporation, Name of Corporation _____________________________________________________ Street Address for Mailing Purposes _____________________________________________________ City State Zip Code _____________________________________________________ Daytime Telephone Number DEFENDANT _____________________________________________________ Defendant’s Name _____________________________________________________ Defendant’s Address _____________________________________________________ City State Zip Code _____________________________________________________ Make, Model and VIN Number of Vehicle _____________________________________________________ Amount owed for Storage _____________________________________________________ Rate of Storage per Day _____________________________________________________ Amount of Advertising _____________________________________________________ Removal Fees _____________________________________________________ TOTAL AMOUNT DUE AT FILING OF CASE WARNING: False Statements made on the application may subject you to criminal and civil liability. I swear or affirm that this application is true and correct to the best of my knowledge and belief. ______________________ Date __________________________________________________ Signature American LegalNet, Inc. www.USCourtForms.com