Ill. Admin. Code tit. 92, § 1470.EXHIBIT A – Written Authorization to Tow Form

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.

(Source: Peremptory rule added at 12 Ill. Reg. 12122, effective July 13, 1988)