Fillable Abandoned Vehicle Report (Arizona Department of Transportation)

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Abandoned Vehicle Report (Arizona Department of Transportation)

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The Abandoned Vehicle Report (Arizona Department of Transportation) form is 2 pages long and contains:

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  • 9 check-boxes
  • 106 other fields

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File type: PDF

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MUST COMPLETE FORM 1 & FORM 2
VEHICLES PURCHASED OR GIFTED DO NOT QUALIFY
Step 1 – Vehicle Removal Written Authorization – Must be completed if vehicle was NOT abandoned on your property
If abandoned on your property, continue to step 2
Property Owner or Lessee Name
Address Vehicle Removed From
City
Removal Authority Given To (Company or Individual Name)
I am the owner or lessee of the property at the physical address stated above and hereby authorize the following individual or company to
remove the vehicle described on the form from that property. I have no interest in the vehicle.
Property Owner or Lessee Signature
Date
Step 2 – Vehicle Inspection – Must be completed by a certified inspector at an MVD field office or Authorized Third Party provider
Vehicle Identification Number
(if VIN appears altered or tampered refer to enforcement)
5
th
10th
17th
License Plate Number
State
Mobile Home
Width _________
Length
__________
Year
Make
Model
Body Style
Motor Coach/
Motorcycle Engine Number
5
th
17th
Federal VIN Label Match
(if not refer to enforcement)
Higher Level Inspection refer to enforcement:
Federal Vehicle Identification/Motorcycle Engine appears to be altered, tampered with, missing or unreadable
Federal Vehicle Identification/Motorcycle Engine is printed in another language than English
Other (Provide details):
Inspected for:
Title Dismantle Salvage Crush Other _____________________
I certify that I have not tampered or altered the vehicle identification information that is listed above. I certify I have
reviewed this document and the information listed above is accurate.
Towing Company/Applicant Name
Signature
Phone Number or Email
(optional)
Date
I certify I have made a physical verification of the vehicle described above.
Inspector Name/Agency
Signature RACF/ID/Badge #
Contact Number
Date
( )
Step 3
– Complete Form 2 – Enclose a $10 check or money order payable to MVD and mail the entire report to
Mail Drop 553M
Abandoned Vehicle Unit Motor Vehicle Division
PO Box 2100
Phoenix, AZ 85001-2100
You may visit: https://www.azdot.gov/motor-vehicles/Vehicle Services/abandoned-vehicles
Form 1 of 2
ABANDONED VEHICLE REPORT
Application for Transfer of Ownership
Authorization to Dispose of Junk Vehicle
Mail Drop 553M
Abandoned Vehicle Unit
PO Box 2100
Phoenix AZ 85001-2100
46-4402 R06/20 azdot.gov
Clear
MUST COMPLETE FORM 1 & FORM 2
VEHICLES PURCHASED OR GIFTED DO NOT QUALIFY
1. Qualification Questionnaire
Has anyone contacted you claiming ownership of this vehicle? If yes Explain:
Do you have the name and address of the owner or lien holder for this vehicle? If yes Explain:
TOW COMPANY ONLY – Has this vehicle been placed on hold or seized at the request of law enforcement? If yes Explain:
If you have a written or verbal contract for storage or repair you DO NOT QUALIFY.
STORAGE & REPAIR FACILITIES –
If you do not have a written or verbal contract you MUST provide proof of certified
notification to the vehicle owner(s).
2. – Vehicle and Applicant Information
Vehicle Identification Number
5
th
10th
17th
License Plate Number
State
Date Towed or Abandoned
(Approx. month/year)
Name of Company or Individual Filing Report
Tow/Company EIN or AZ DL/ID #
or NONE
(required)
Phone Number
( )
Mailing Address
City
State
Zip
Location Where Vehicle Stored (physical address)
City
State
Zip
County vehicle is located: Apache 01 Cochise 02 Coconino 03 Gila 04 Graham 05 Greenlee 06
Maricopa 07 Mohave 08 Navajo 09 Pima 10 Pinal 11 Santa Cruz 12 Yavapai 13 Yuma 14 La Paz 15
3. – Indemnity Statement
I certify that the vehicle described above was towed/abandoned and that all available information concerning the
vehicle and persons claiming an interest herein is reported on this form and is correct to the best of my
knowledge. I will protect and indemnify the Motor Vehicle Division, Arizona Department of Transportation, and its
agent against all claims and lawsuits of whatever nature which may arise because of the issuance of a transfer of
ownership/authorization to dispose of junk vehicles, based on this report and Arizona law. I further certify that I
will immediately notify the Motor Vehicle Division, Abandoned Vehicle Unit if contacted by any person who
demonstrates proof of ownership and financial responsibility of the vehicle.
Authorized Signature
Printed Name
Acknowledged before me this date.
Notary or MVD Agent Signature
Date
County
State
Commission Expires
Within 24 hours of vehicle being released to the lawful owner or lien holder, the ABV Unit must be notified at
ABVPublic@azdot.gov
Form 2 of 2
ABANDONED VEHICLE REPORT
Application for Transfer of Ownership
Authorization to Dispose of Junk Vehicle
Mail Drop 553M
Abandoned Vehicle Unit
PO Box 2100
Phoenix AZ 85001-2100
46-4402 R06/20 azdot.gov
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Completed 22 September 2020

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