Form Hsmv 82012 - Application For Towing And Storage Certificate Of Destruction Page 2

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7 LAW ENFORCEMENT CHECK

(Not Required if there is a Current Florida Title Record)

Date: ____________________ Vehicle/Vessel/Mobile Home Identification Number: ________________________________________

I hereby certify that I have physically verified the vehicle identification number shown above on the motor vehicle described on the

reverse side of this form and find the numbers to be the same. I further certify that I have made inquiry in the Florida Crime

Information Center (FCIC) and the National Crime Information Center (NCIC) and find that the vehicle identification number shown

above has not been reported as stolen.

I hereby certify that I have made inquiry in the Florida Crime Information Center (FCIC) and the National Crime Information Center

(NCIC) and find that the identification number for the vessel or mobile home shown above has not been reported as stolen.

Agency Name: ___________________________________________________________

Badge Number: ______________________

Law Enforcement

Officer's Signature: _________________________________ Printed Name: ___________________________________________

TOWING AND STORAGE CHECKLIST FOR CERTIFICATE OF DESTRUCTION

You should review section 713.78 and 713.785, Florida Statutes, or DMS Procedure TL-26 prior to making application for a Certificate of Destruction.

FLORIDA RECORD:

OUT -OF-STATE:

HSMV 82012

HSMV 82042, or form HSMV 82012 (section 7)

Verification as to title/lien status OR affidavit stating previous

state "UNKNOWN" and a good faith effort has been made.

Notice of claim of lien including:

Statement of possession by the tow company

That a lien is claimed and subject to enforcement, as provided by Section 713.78, Florida Statutes

That owner or lienholder has the right to a hearing

Description of vehicle/vessel, year, make and vehicle/vessel identification number

That charges have accumulated (total amount owed, itemized)

Name of person who authorized the tow

Signature of authorized agent for the towing company

Date of the Notice of Claim of Lien and date of the towing

Tow company's complete name, address and telephone number

That any motor vehicle/vessel which remains unclaimed, for which towing and storage charges remain unpaid,

may be sold free of all prior liens after 35 days if the vehicle or vessel is more than 3 years of age or after 50

days, if the vehicle or vessel is 3 years old or less.

Notice of sale including: (this information may be included in the Notice of Claim of Lien)

Date, time and location of sale

Location of vehicle/vessel

Description of vehicle/vessel, year, make and vehicle/vessel identification number

Date of towing

Tow company's complete name, address and telephone number

Total charges for towing and storage (itemized)

Signature of authorized agent for towing company

Copy of newspaper advertisement, showing the name of the newspaper and date the advertisement was published, including:

Date, time and location of sale

Description of vehicle/vessel, year, make and vehicle/vessel identification number

Proof of Notification to law enforcement (if applicable), along with a copy of the letter and proof verifying a record check of NMVTIS.

Copy of police report, impound storage receipt or a copy of the tow ticket (for private tow) or trip sheet, if previous state where vehicle/vessel was

registered is "UNKNOWN."

Proof of reporting to NMVTIS (if applicable). Not applicable to mobile homes.

Certificate of Destruction fee

CHECK LIST FOR CERTIFICATE OF DESTRUCTION (WHEN OWNER IS TRANSFERRING TITLE FOR TOWING & STORAGE CHARGES)

Florida or out of state title

A copy of the trip sheet or tow ticket

HSMV 82012 (if title is out of state, section 7 of this form must be completed)

Proof of reporting to NMVTIS (if applicable)

Certificate of Destruction fee

HSMV 82012 (Rev. 06/13) S