Cities Index.
Claim- Jose Alfredo Escobedo_Redacted.pdf

Rialto City Council
September 22, 2026

Document
Claim- Jose Alfredo Escobedo_Redacted.pdf
Meeting
September 22, 2026
Body
Rialto City Council
Original file
5.0 MB
Text extracted from the city's file for reading and search. Open the original on legistar.granicus.com. That file is the official record.

CITY CLERK'S DATE STAMP

CITY OF RIALTO

LIABILITY CITY OF RIALTO

CLAIM FOR DAMAGES
2026 SEP -9 PM 2: 18

TO PERSON OR PROPERTY

RECEIVED

CITY CLERK

1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code $911.2).

2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:

3. READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office

4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:

JOSE ALFRED ESCOBEDO

FULL NAME DATE OF BIRTH

HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.

ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE

NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
8•10-26 TIME: 1215

1. WHEN DID DAMAGE OR INJURY OCCUR? DATE:

2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.

Where appropriate, give street names and addresses, measurements and landmarks. 342 ORANELLON ALE ANTO CA VISI

3. HOW DID DAMAGE OR INJURY OCCUR?
HE WAS ToO FOR REGISTRATION, BUT REL

WAS ALTALLY VALID

4. WERE POLICE AT THE SCENE? O YES NO WERE PARAMEDICS AT THE SCENE? DYES LANO

5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.

L. MOCKENHAUT TUNED VEHILLE

6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 851.80 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.

DAMAGES INCURRED TO DATE:

Item/Date: POLILE RELEASE $210.00 Amount: $
Item/Date: PEDES: TW $ 635.00 Amount: $
•
Formal Complaint and Demand for Reimbursement -
Wrongful Vehicle Tow
Complainant: Jose Alfred Escobedo
Address:

Telephone:

Email: 2026 SEP - 9 PM 2: CITY OF RIALTO
Vehicle: 2010 Honda Insight
VIN:

Date of Tow: August 10, 2026
Location of Tow: Street in front of my residence at 3421 N. Orangewood Ave, Rialto, California
Police Report/CHP 180 Number: 932609999
Tow Company: Pepe's Towing Service
To Chief Kling and the City of Rialto:

I submit this formal complaint and demand for reimbursement concerning the wrongful removal and impoundment of my 2010 Honda Insight by, or at the direction of, the Rialto Police Department on August 10, 2026.

Statement of Facts
On August 10, 2026, my vehicle was parked on the public street directly in front of my residence when it was towed at the direction of the Rialto Police Department.

The attached Vehicle Report Form CHP 180 identifies the asserted authority for removal as California Vehicle Code section 22651(o)(1)(A) and states that the vehicle's registration was expired for more than six months and one day. The report also states that the vehicle was parked on a city street without front or rear license plates. Its comments include the notation "expired registration 12/99."
That expiration notation was incorrect. I recently purchased the vehicle from the City of Riverside and was in the process of transferring ownership. The attached certificate of title and registration documentation show an expiration date of December 31, 2099, not December 1999.

It appears that the expiration date "12/31/2099" was misread, incorrectly entered, or improperly interpreted as "12/99." Consequently, the factual premise used to justify removal under section 22651(o)(1)(A) was false: the vehicle's registration had not expired for more than six months.

The CHP 180 further records dents, scratches, and paint damage around the vehicle; miscellaneous personal property inside it; and the availability of Axon footage. I request that all related evidence be preserved while this complaint and reimbursement demand remain pending.

CITY OF
Grounds for Complaint
California Vehicle Code section 22651(0)(1)(A) permits removal under specified circumstances involving registration that has been expired for more that six ~ months. The registration record in this matter establishes an expiration date of December 31, 2099. Accordingly, the reported expiration necessary to support removal under that provision did not exist.

Although the CHP 180 also mentions the absence of license plates, the report identifies expired registration under section 22651(o)(1)(A) as the towing basis.

Please identify any separate statutory authority the Department contends authorized the tow based solely on the reported absence of plates and provide the facts and records supporting reliance on that authority.

The Department should have accurately reviewed and verified the vehicle's registration status before ordering its removal. The apparent misreading of 2099 as 1999 caused the wrongful tow and directly resulted in the fees described below.

Demand for Reimbursement
As a direct result of the wrongful tow, I incurred the following expenses:

Expense Amount
Rialto Police Department vehicle-release fee $216.80
Pepe's Towing Service towing and storage fees $635.00
Total reimbursement demanded $851.80
I demand reimbursement in the total amount of $851.80. Copies of the receipts and supporting records are enclosed
Payment should be made payable to Jose Alfred Escobedo and mailed to Please provide a written response
within 15 calendar days after receipt of this complaint confirming that the Department will reimburse the full amount.

If the City requires submission on a particular claim form or considers this correspondence insufficient to initiate its claims process, please immediately provide the required form and written instructions. This letter is intended to give formal notice of my claim and demand arising from the August 10, 2026 tow, without waiving any applicable rights or remedies.
2026 SEP - 9
Request for Investigation and Records CITY OF RIALTO

CITY CLES RECEIVES
I request that the Rialto Police Department:

1. Investigate the tow, including the officer's interpretation and verification PM 2:21 registration-expiration date.

2. Correct its records to reflect that the vehicle's registration expiration date was December 31, 2099, rather than December 1999.

3. Rescind or invalidate the tow determination to the extent permitted by law.

4. Reimburse the full $851.80 in release, towing, and storage charges.

5. Provide the name and identification number of every officer or employee involved in the tow decision.

6. Provide the specific legal and factual basis for the removal, including any authority allegedly arising from the reported absence of license plates.

7. Provide a written disposition of this complaint and identify any complaint or claim number assigned to it.

Preservation of Evidence
The City and Department are directed to preserve all records and evidence concerning this incident, including:
• The complete CHP 180 and all supplements or amendments. • All Axon body-worn-camera, in-car-camera, and other video footage. • Photographs of the vehicle, VIN, registration documents, license-plate areas, and location.
• Computer-aided dispatch records, call notes, radio traffic, and event chronology. • DMV, CLETS, or other registration inquiries and their complete results. • Tow requests, authorizations, dispatch records, inventories, and communications with Pepe's Towing Service.
• Officer notes, reports, emails, text messages, internal messages, and supervisory reviews.
• Records showing the legal authority relied upon to order and approve the tow.

This preservation request includes electronically stored information and associated metadata. Please prevent any automatic deletion or routine destruction of responsive evidence, particularly Axon footage and dispatch recordings.

Enclosures
2026 SEP - 9 CITY OF

1. Vehicle Report Form CHP 180.

2. Certificate of title.

PM 2:21 RIALTO

3. Registration documentation showing expiration on December 31, 2099.

4. Receipt for the $216.80 vehicle-release fee.

5. Receipt from Pepe's Towing Service for $635.00.

6. Proof of purchase from the City of Riverside.

7. Photographs or other supporting evidence, if applicable.

I request prompt correction of this error and full reimbursement of the costs it caused. Nothing in this complaint constitutes a waiver of any right, claim, remedy, or applicable deadline.

Sincerely,
Jose Alfred Escobedo
Date signed: 51126

STATE OF CALIFORNIA

DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
VEHICLE REPORT TE: CAP 10 IS FURNISHED TO ALL PER

STORED FICERS BY THE CALIFORNIA HIGHWAY PATE
CHP 180 (Rev. 4-16) OPI 061
REPORTING DEPARTMENT LOCATION CODE DATE / TIME OF REPORT NOTICE OF STORED VEHICLE FILE NO.

DELIVERED PERSONALLY
RIALTO PD 3609 08-10-26 1215 932609999
LOCATION TOWED / STOLEN FROM ODOMETER READING VIN CLEAR IN SVS? X YES NO DATE / TIME DISPATCH NOTIFIED LOG NO. 3421 N ORANGEWOOD AVE DIGITAL LIC. CLEAR IN SVS? X YES • NO 08-10-26 1215 N/A YEAR MAKE MODEL BODY TYPE COLOR LICENSE NO. • ONE MONTH/YEAR STATE 10 HONDA INSIGHT 4 DR WHITE NONE X TWO 12-99 CA
VEHICLE IDENTIFICATION NO. ENGINE NO. VALUATION BY
N/A - 0500 501-4000
400t:

REGISTERED OWNER 7 I SAME AS RIO LEGAL OWNER

CY RIVERSIDE GS FLEET MAINT CY RIVERSIDE GS FLEET MANTI 8095 LINCOLN AVE 8095 LINCOLN AVE OF
RIVERSIDE CA 92504 RIVERSIDE CA 92504

PM RIAL
STORED • IMPOUNDED RELEASED • RECOVERED - VEHICLE / COMPONENT

TOWING / STORAGE CONCERN (NAME, ADDRESS, PHONE) STORAGE AUTHORITY / REASON PEPE'S TOWING (909) 574-1490 CVC 22651(OX(1)(A)
REASON FOR STOP AIRBAG? DRIVEABLE? VIN SWITCHED?
EXPIRED REGISTRATION X YES 01 • NO
LI NO JUNK [X] UNK • YES XINO

CONDITION YES NO ITEMS YES NO ITEMS YES NO ITEMS YES NO TIRES / WHEELS

CONDITION
WRECKED X SEAT (FRONT) REGISTRATION CAMPER X : LEFT FRONT FAIR BURNED HULK per 431(c) CVC X SEAT (REAR) X ALT. / GENERATOR VESSEL AS LOAD RIGHT FRONT FAIR VANDALIZED X [RADIO BATTERY FIREARMS X LEFT REAR FAIR
ENG. / TRANS. STRIP X TAPE DECK X DIFFERENTIAL OTHER RIGHT REAR FAIR MISC. PARTS STRIP X TAPES X TRANSMISSION SPARE UNKNOWN

BODY METAL STRIP X OTHER RADIO AUTOMATIC (HUB CAPS NO
SURGICAL STRIP per 431(b) CVC X IGNITION KEY X MANUAL X SPECIAL WHEELS NO RELEASE VEHICLE TO: X R/O OR AGENT 7 AGENCY HOLD 22850.3 CVC GARAGE PRINCIPAL / AGENT STORING VEHICLE (SIGNATURE)

DATE / TIME
ERNIE PEPE'S TOW 08-10-26 1230
NAME OF PERSON / AGENCY AUTHORIZING RELEASE I.D. NO.

CERTIFICATION: 1, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY 2320 08/11) AUTHORIZEO AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLE

SIGNATURE OF PERSON AUTHORIZING RELEASE SIGNATURE DEPERSON TAKING POSSSSSION = er
• STOLEN VEHICLE/ COMPONENT C EMBEZZLED VEHICLE • PLATE(S) REPORT DATE / TIME OF OCCURRENCE DATE / TIME REPORTED NAME OF REPORTING PARTY (R/P) DRIVER LICENSE NO. / STATE

LAST DRIVER OF VEHICLE DATE / TIME ADDRESS OF R/P TELEPHONE OF R/P ( )

SIGNATURE OF PERSON MAKING REPORT

I CERTIFY OR DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.

REMARKS
[LIST PROPERTY, TOOLS, VEHICLE DAMAGE, ARRESTS)
L. MOCKENHAUPTO YES XINO
VEHICLE PARKED ON CITY STREET WITHOUT A FRONT OR REAR LICENSE PLATE. THE REGISTRATION FROM THE VIN WAS EXPIRED OVER SIX MONTHS AND ONE DAY. DENTS, SCRATCHES, PAINT DAMAGE 360 OF VEHICLE. MISCELLANEOUS PROPERTY LOCATED INSIDE VEHICLE. AXON FOOTAGE AVAILABLE.

FRONT LEFT SIDE RIGHT SIDE REAR
TOP
SIGNATURE OF OFFICER TAKING REPORT I.D. NO SUPERVISOR REQUIRED NOTICES SENT TO REGISTERED • YES L. MOCKENHAUPT 02692 KB AND LEGAL OWNERS PER 22852 CVC? NO
An Internationally Accredited Agency Chp180_0
CERTIFICATE OF TITLE ВІБАТ
17309102309 VEHICLE HISTORY

AUTOMOBILE PERM EXEMPT

VENCHED NUMBER MODEL MAKE PLATE NUMBER
2010 HOND 1339076

BODY TYRE MODE X/ WEIGHI FUEL TRANBEER DATE EXPRATIONDATE ЧН 12/31/2099
YR 18E
SOLO. GLASS TYR MO EQUIPMT TRUSE NUMBER ISSUE DATE
2009 EY RY 11/04/09

MOTORCVOLE ENGINE NUMBER ODOMETER DATE ODOMETER READING 08/30/2009 25 MI
2026 SEP - 9 PM 2:21 CITY OF RIALTO

REGISTERED O ACTUAL MILEAGE

CY RIVERSIDE GS FLEET

MAINTENANCE
8095 LINCOLN AVE
RIVERSIDE CA 92504
WATERMARK. HOLD TO LIGHT TO VIEW
I certity (or declare) under penatty of periury vides the lave of the State of Califomla that THE SIGNATURE(S) BELOW RELEASES INTEREST IN THE VEHICLE E VOID WITHOUT BEAR WATERMARK. HOLD TO LIGHT TO VIEW.

FIRES STORED OWNE

SIGNATURE OF HEGISTERED OWNER
ederal and State low requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in ines and/or imprisonment
BEAR' The odometer how reads 1213154 1510151 (no tenthe), miles and to the best of my knowledge reflects the actuat mileage unless one of the followigg statements is checked.

WARNING C Odom ading is not the poll mlleage, [J Mileage excade the odometer mechanical limits. certify (on deciare) under nalty of perjury under the laws of the State of California that the foregoing la true and correct VOID WITHOU 744 202L

EAT OF RIVERSIDE X

TED MINE OF SELLEN CO RES

JUST SUNDEAS ACTIN SE RIVERSIDE

IMPORTANT READ CAREFULLY
Any change of Lienholder (holder of security interest) must be reported to the Department of Motor Vehicles within 10 days.

UENHODERIST

2. Signature releases interest in vehicle. (Company
names must be countersigned)
Release Date
CA120998215
007956 REG. 17.30RS (REV,7/07)
KEEP IN A SAFE PLACE - VOID IF ALTERED?
2026 SEP - 9 CITY OF RIAL

THIS VALIDATED REGISTRATION CARD OR A FACSIMILE COPY IS TO BE KEPT WITH SHE VEHICLE FOR WHICH IT IS ISSUED. THIS REQUIREMENT DOES NOT APPLY WHEN THE NEED NOT BE DISPLAYED. PRESENT IT TO ANY PEACE
OFFICER UPON DEMAND. IF YOU DO NOT RECEIVE A RENEWAL NOTICE, USE THIS FORM

TO PAY YOUR RENEWAL FEES OR NOTIFY THE DEPARTMENT OF MOTOR VEHICLES OF THE PLANNED NON-OPERATIONAL STATUS (PNO) OF A STORED VEHICLE. RENEWAL FEES MUST

BE PAID ON OR BEFORE THE REGISTRATION EXPIRATION DATE OR PENALTIES WILL BE DUE PURSUANT TO CALIFORNIA VEHICLE CODE SECTIONS 9552 - 9554.

EVIDENCE OF LIABILITY INSURANCE FROM YOUR INSURANCE COMPANY MUST BE PROVIDED TO THE DEPARTMENT WITH THE PAYMENT OF RENEWAL FEES. EVIDENCE OF LIABILITY

INSURANCE IS NOT REQUIRED WITH REGISTRATION RENEWAL OF OFF-HIGHWAY VEHICLES, TRAILERS, VESSELS, OR IF YOU FILE A PNO ON THE VEHICLE.

WHEN WRITING TO DMV, ALWAYS GIVE YOUR FULL NAME, PRESENT ADDRESS, AND THE VEHICLE MAKE, LICENSE, AND IDENTIFICATION NUMBERS.
**************DO NOT DETACH - REGISTERED OWNER INFORMATION******* **** REGISTRATION CARD VALID FROM: 07/16/2026 TO: 07/16/2027

MAKE YR MODEL TYPE LIC LICENSE NUMBER
HOND 2010

BODY TYPE MODEL MP MO VEHICLE ID NUMBER
4H HH

TYPE VEHICLE USE DATE ISSUED CC/ALCO DT FEE RECVD PIC USE TAX STICKER ISSUED AUTOMOBILE 08/11/26 36 08/11/26 3 219 H2766142
PR EXP DATE: 12/31/2099

REGISTERED OWNER AMOUNT PAID
ESCOBEDO JOSE ALFRED $ 442.00

AMOUNT DUE AMOUNT RECD
$ 442.00 CASH :

CHCK :

RIALTO CRDT : 442.00
CA 92377
-

LIENHOLDER
F00 606 C4 0044200 0001 CS F00 081126 11 9YJM953 870
•
City of Rialto
POLICE
150 S Palm Ave
Rialto, CA 92376-6487
+1 (909) 820-2525
City of Rialto
2026 SEP - 9 PM 2:21 CITY OF RIALTO
08/11/2026 12:56PM CITY CLERK RECEIVED
004806-0008 PD24-000011341
Payment effective date 08/11/2026

MISCELLANEOUS
Vehicle Release Fee
(629833)
2027 629833
1 @ $216.80 $216.80
Payment Id: 109093
--------
$216.80
Subtotal $216.80
Total $216.80
POLICE CC MERCHANT $216.80
MasterCard ************1647
Ref=5ed490e3-4fba-4543-926e-202af2af6881
Auth=090612
Change due $0.00
Paid by: JOSE ESCOBEDO
Thank you for your payment
City of Rialto COPY

DUPLICATE RECEIPT
Pepe's Towing Service Impound Receipt
PO Box 7450, Moreno Valley CA 92552 Printed 8/11/2026
Phone: (951) 682-5682 | Fax: (951) 682-5030
Turing
Released To JOSE ESCOBEDO Phone:
invoice# 26-0810-86843 Reason for Impound 22651-J ILLEGAL PARKING WITHOUT PLATES OR REG Call # 86843 VIN Number
Case # 932609999 Model 2010 Honda Insight (White)
Case # 932609999 License Plate NONE
Account RIALTO PD Drivable Yes
Date/Time Requested 8/10/2026 12:20 PM Keys No
Date/Time Dispatched 8/10/2026 12:21 PM Towed from 3421 N Orangewood Ave, Rialto, CA 92377, USA Date/Time Arrived to scene 8/10/2026 12:25 PM Stored at Rialto Yard Date/Time Towing Time: 8/10/2026 12:32 PM 2775 N Locust, Rialto CA 92377 Date/Time Completed: 8/10/2026 1:05 PM
Driver Ernie V. 2026
Truck TRK 36
Date/Time Released: 8/11/2026 1:19 PM
Days Held in Impound 2 days

FELY CITY OF RIATE
Notes
Price E PM
Storage charges Quantity
(Storage - Storage Fees) Impounds/Storage: Daily Impound Rate 2 $77.00 Towing charges Quantity Price Line Total
(Towing) TOWING FEE PORT TO PORT (price per hour) 1(ah) $360.00 $360.00 (Towing) Admin Fee $121.00 $121.00
Towing SubTotal $481.00
Storage - Storage Fees SubTotal $154.00
Subtotal $635.00
Taxes $0.00
Grand Total $635.00
Amount Due: $0.00 / Paid
MasterCard payment (Ref # CC 1647 APV 03416Z) of $635.00 applied on 8/11/2026 All towing services sales are final at time of payment. By authorizing payment, you agree to the following terms:

No Cancellations/Changes: Once service is dispatched or rendered, payments cannot be canceled or modified.

No Refunds: All fees (towing, recovery, storage, etc.) are non-refundable.

No Chargebacks: Disputing valid charges may lead to additional fees.

By proceeding with payment, you confirm acceptance of these terms.

Pepe's Towing Service appreciates your business; if you have any questions regarding this invoice, please contact us at 951-682-5682. Thank you.

I Have been advised that my vehicle may be damaged if winched, towed, unlocked, jump started, tire changed or left on unattended premises. I recognize the difficulty involved and i agree not to hold Pepe's Towing Service responsible for such damages should it result. 1, the undersigned do hereby certify that I am legally authorized and entitled to take possession of the vehicle described and all personal property therein. I have received the vehicle and all personal property in satisfactory condition.

Signature: Date:

CA# 117433 USDOT: 1005094
Upon request, you are entitled to receive a copy of the Towing and Storage Fees and Access Notice https://app.towbook.com/impounds/Impound?id=29418581#Payment 1/1 Pepe's Towing Service Impound Receipt
PO Box 7450, Moreno Valley CA 92552
Phone: (951) 682-5682 | Fax : (951) 682-5030 Printed 8/11/2026 Turing Cerio
Released To JOSE ESCOBEDO Phone:

Invoice# 26-0810-86843 Reason for Impound 22651-J ILLEGAL PARKING WITHOUT PLATES OR REG Call # 86843 VIN Number
Case # 932609999 Model 2010 Honda Insight (White)
Case # 932609999 License Plate NONE
Account RIALTO PD Drivable Yes
Date/Time Requested 8/10/2026 12:20 PM Keys No
Date/Time Dispatched 8/10/2026 12:21 PM Towed from 3421 N Orangewood Ave, Rialto, CA 92377, USA Date/Time Arrived to scene 8/10/2026 12:25 PM Stored at Rialto Yard Date/Time Towing Time: 8/10/2026 12:32 PM 2775 N Locust, Rialto CA 92377 Date/Time Completed: 8/10/2026 1:05 PM
Driver Ernie V.

Truck TRK 36
Date/Time Released: 8/11/2026 1:19 PM
Days Held in Impound 2 days
Notes
Storage charges Quantity Price Line Total
(Storage - Storage Fees) Impounds/Storage: Daily Impound Rate 2 $77.00 $154.00 Towing charges Quantity Price Line Total
(Towing) TOWING FEE PORT TO PORT (price per hour) 1(2h) $360.00 $360.00 ¡Towing) Admin Fee $121.00 $121.00
Storage - storage res SubTotal $481.00
$154.00
Subtotal $635.00
Taxes $0.00
Grand Total $635.00
Amount Due: $0.00 / Paid
MasterCard payment (Ref # CC 1647 APV 03416Z) of $635.00 applied on 8/11/2026 All towing services sales are final at time of payment. By authorizing payment, you agree to the following terms:

No Cancellations/Changes: Once service is dispatched or rendered, payments cannot be canceled or modified.

No Refunds: All fees (towing, recovery, storage, etc.) are non-refundable.

No Chargebacks: Disputing valid charges may lead to additional fees.

By proceeding with payment, you confirm acceptance of these terms.

Pepe's Towing Service appreciates your business; if you have any questions regarding this invoice, please contact us at 951-682-5682. Thank you.

Damage Disclaimer:

I Have been advised that my vehicle may be damaged if winched, towed, unlocked, jump started, tire changed or left on unattended premises. I recognize the difficulty involved and I agree not to hold Pepe's Towing Service responsible for such damages should it result 1, the undersigned do hereby certify that I am legally authorized and entitled to take possession of the vehicle described and all personal property therein. I have received the vehicle and all personal property in satisfactory condition.

Signature: Date:

CA# 117433 USDOT: 1005094
Upon request, you are entitled to receive a copy of the Towing and Storage Fees and Access Notice https://app.towbook.com/impounds/Impound?id=29418581#Payment 1/1

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