CITY OF HEMET
Code Compliance Divsion
445 E. Florida Avenue • Hemet, CA 92543
Phone (951) 765-2339 Fax (951) 765-2359
ABANDONED VEHICLE ABATEMENT PROGRAM (AVA)
Authorization form to request the removal of inoperative, wrecked, dismantled or abandoned
vehicle(s) on private property through the AVA Program.
I hereby request the following vehicle(s) described below to be removed from:
________________________________________________________________________
Address and/or Assessor Parcel Number
Under penalty of perjury I deny responsibility for the presence of the vehicle(s) and/or disclaim
any future interest in the vehicle(s). In requesting the City of Hemet to remove the vehicle(s), I
understand and agree that I am relieving the City of Hemet and its agents from any and all
liability.
Vehicle 1: __________________ _________ ______________________________
License Plate Number State Vehicle Identification Number (VIN)
_
_________ _______________ _______________ ______________ ____________
Year Make Model Body Type Color
Vehicle 2: __________________ _________ ______________________________
License Plate Number State Vehicle Identification Number (VIN)
__________ _______________ _______________ ______________ ____________
Year Make Model Body Type Color
Vehicle 3: __________________ _________ ______________________________
License Plate Number State Vehicle Identification Number (VIN)
_
_________ _______________ _______________ ______________ ____________
Year Make Model Body Type Color
C
heck as applicable:
Property Owner/Agent of Tenant Registered Owner of Vehicle Legal Owner of Vehicle
Print Name: __________________________________________________________________________
Mailing Address (if different from above): __________________________________________________
Contact Phone and/or email: _____________________________________________________________
________
_______________________________ ________________________
Signature Date
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signature
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