Ill. Admin. Code tit. 92, pt. 1470, subpt. H, exh. A
1) I, __________________, am the owner or owner's agent (spouse, child, brother, sister, parent, attorney or court appointed legal representative ONLY may be considered to be owner's agent) of the following vehicle:
2) __________________________________________________________________________________
Make Model Year
______________________________________________________________________________________
VIN #
______________________________________________________________________________________
License Plate # (Include State)
3) My address is:
______________________________________________________________________________________
Street
______________________________________________________________________________________
City State Zip Code
4) This authorization is hereby given to ____________________ of__________________
__________________________________________ , to tow the vehicle described above.
5) I hereby state and affirm, under oath, that I am the duly authorized owner or owner's agent of the vehicle described above.
Date: ______________________ Signature: _____________________________
Instructions - Written Authorization to Tow Form
All parts of this form must be legible, in ink or typewritten, and completely filled out.
Line 1 - Fill in your complete name. Note that only certain persons may qualify as owner's agent.
Line 2 - Give make, model and year of vehicle being towed. Also include VIN (Vehicle Identification Number) number and license plate number (including state).
Line 3 - Provide your complete mailing address.
Line 4 - Fill in full name of person towing the vehicle and complete mailing address.
Line 5 - Sign in ink and date. Note that the permission you provide in this form is under oath.
Special Note: Other State and local requirements concerning proof of ownership and identification of owner or owner's agent may have to be met before the vehicle may be released.
Ill. Admin. Code tit. 92, pt. 1470, subpt. H, exh. A