Impounded Property Collection Request Form

Impounded Property Collection Request Form
Submit this form to request the release or collection of property held by the impound facility. Please provide accurate information to help us verify your request.
Full Name of Claimant
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Relationship to Property
Type of Impounded Property
Description of Impounded Property
Date Property Was Impounded
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Requested Pickup Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of Claimant (draw below)
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