This form is to be used on and after January 1, 2019, by owners, insurance companies, towing companies, and other persons
requesting the release of a vehicle from a towing storage lot following an accident. This form may be faxed, mailed, emailed, sent
by other electronic means, or hand-delivered to the towing company.
The owner, or person designated in writing by the owner and witnessed by a third party, insurer, or the insurer’s representative
may inspect the vehicle at the towing company’s storage lot during regular business hours, may remove any personal property*
from the vehicle, and may report any damage to the vehicle to the towing company at the time of inspection.
By signing this form the owner, lienholder or insurance company acknowledges that he or she has been informed pursuant to ARS
28-4847 (A) (7) that the towing company is presumptively not responsible for any loss of personal property or damage to the
vehicle that is not disclosed to the towing company before the owner, insurer, or insurer representative removes the vehicle from
the towing company’s storage lot.
Section 1 (Required for release of vehicle to owner or Insurance Company Representative)
Vehicle Identification Number
Owner’s Name (first, middle, last, suffix)
( )
Towing/Storage Detailed Statement of Charges Paid
AUTHORIZATION FOR RELEASE OF VEHICLE (BY OWNER OR LIENHOLDER)
Section 2 (Required if vehicle being released to owner)
Release of Vehicle Authorized by (Owner or Lienholder) - Persons name or organization must show proof of ownership as specified below
Vehicle To Be Released To (Name of Company/Organization and Name of Driver)
Signature of Person Vehicle Released to or the Owner’s Insurance Company Name:
AUTHORIZATION FOR RELEASE OF VEHICLE (TO INSURANCE COMPANY REPRESENTATIVE)
Section 3 (Required if vehicle being released to Insurance Company Representative)
If written consent of the owner is not obtained pursuant to ARS 28-4847 (A) (6), the insurer may designate the person below to take possession
of the vehicle if the insurance company representative attests as follows:
“As the designated representative of ______________________________________ Insurance Company, I declare that the vehicle owner has authorized
______________________________________ Insurance Company to remove the vehicle from the towing storage lot.”
Name of Insured (if different than owner) (If applicable)
Name of Insurance Company (If applicable)
Name of Insurance Company or Representative to Whom Vehicle is to be Released (If applicable)
Street Address of Designated Insurer Representative
( )
( )
Claim Number (If applicable)
Signature of Insurance Company Representative to Whom Vehicle is to be Released
Required Proof of Ownership
A person must submit a government issued photo identification and at least one of the following:
• A valid certificate of title.
• Proof of current vehicle registration, not including a restricted use three-day permit.
• A repossession affidavit, a hold harmless liability release from legal claims and, if applicable, a proof of lien on the vehicle.
• An insurance company release pursuant to section 28-4847.
• A certified motor vehicle record.
• Proof of a bona fide security interest or other financial interest in the vehicle that exists at the time of the tow.
*NOTE: Personal Property does not include vehicle parts, vehicle equipment or vehicle accessories.
REQUEST FOR RELEASE OF VEHICLE
(From Towing Company Storage Lot)
46-8925 R10/18
