Vehicle Immobilization
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1STATE OF SOUTH CAROLINA
)
IN THE COURT OF
)
GENERAL SESSIONS
)
______Judicial Circuit
County of ___________________
)
)
STATE OF SOUTH CAROLINA
)
Petitioner
)
)
VEHICLE IMMOBILIZATION
Vs.
)
)
___________________________
)
GS
Case Number______-
-____-_______
Defendant
)
Date of Birth_________________
)
SCDL #_____________________
Pursuant to S.C. Code Ann. § 56-5-2942(J), you are required to surrender all
license plates and vehicle registration numbers to the Department of Motor
Vehicles so that all vehicles registered to or owned by you may be
immobilized as a result of this conviction. Upon notification from the
DMV, you must surrender the license plates from all vehicles listed below as
required by law.
Please list the make and model of each vehicle registered in your name, the
corresponding license plate number and vehicle registration number of each
vehicle.
Vehicle Make and Model
License Plate Number
Registration Number
I hereby certify that the information I have provided is true, accurate, and
complete under penalty of perjury in accordance with S.C. Code Ann. § 16-
9-10.
_________________________________
_______________________________
Defendant
D ate
SCCA / 220 (01/04)
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