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ANCE COMPANY NAME OF VEHICLE OWNER VEHICLE LICENSE NUMBER STATE MAKE REGISTRATION EXPIRES Check if Permanent VIN Registration MODEL STYLE INSURANCE POLICY NUMBER (Check if Business) Towed due to Damage: 1 No 2 Yes CURRENT ADDRESS DAMAGE: EST. AMOUNT 1 Disabling 4 Minor 2 Functional 88 Unknown 3 None VEHICLE REMOVED BY 1 Rotation 2 Owner Request 3 Driver 77 Other, Explain in Narrative CITY & STATE ZIP CODE COLOR TRAILER # LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permane.

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