Location/Address of Private Property Removal (if not located at an address, list coordinates) Property Owner or Manager Name Address email Phone Date BY SIGNING BELOW, I AM STATING THAT I AM AN OWNER AND/OR MANAGER OF THE LISTED PROPERTY FROM WHICH THE BELOW LISTED VEHICLE IS TO BE REMOVED, AND THAT THE VEHICLE IS DEEMED ABANDONED OR HAS BEEN LEFT ON THE PROPERTY WITHOUT AUTHORIZATION. BEING THE OWNER AND/OR MANAGER IN CHARGE I HEREBY AUTHORIZE NWA TOWING & RECOVERY TO REMOVE THE LISTED VEHICLE. I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS NWA TOWING & RECOVERY FOR ANY CAUSE ARISING OUT OF THE REMOVAL OF THE LISTED VEHICLE. I ALSO ACKNOWLEDGE THAT BY LAW I AM REQUIRED TO KEEP A COPY OF THIS FORM AND PROVIDE IT TO THE OWNER/RESPONSIBLE PARTY OF THE VEHICLE/PROPERTY REMOVED UPON REQUEST. (A.C.A 27-50-1101) Signature (type full legal name) Vehicle Information Year Make Model Color VIN Plate & State
