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F & M Towing & Auto Salvage, Imo. <br />3001 Main Street Ytl 6424 <br />Springfield, Oregon 97478 <br />Phone (5411746-5615 a Toll Free 1$00-386-5615 <br />24-HOUR TOWING / <br />y~ IL11E~/" 4 20 <br />MAKE IGr7" d YEAR LC. <br />SODYTYPE 7 t <br />lj<W~ STATEC,&~ REO. NO. <br />DESCRIFrnONOFCHARGE <br />$ <br />A <br />MO <br />UUNTT <br />/ <br />TOWED <br />'G 4 ~~y <br /> <br />{ <br />~ <br />~ <br />' <br />FROM <br /> <br />✓ <br />TOWED <br />TO <br />STORAGE:;.. <br />AT <br />RETOW <br />- - <br />TO <br />FUSSES <br />OUTSIDE LABOR <br />& RECOVERY' <br />DOLUE <br />AUTHORIZE DTOW <br />TOTAL <br />~ <br />Tlto undasiped agree, jointly and severally, he pay F& M Towing & Auto Sd- CHARGES <br />n . <br />V WI wininthin 1301& fromdatoormvica.thcmauntactimb boss, <br />We. y <br />. far the soviet, described above. Imaad n the rare of 10%pa mmen Rom due <br />shall also be laid. The undersigned fitness aye and uldetvaod flea F & M Towing & Auto Savage. Inc. may forward this secomt to their <br />utomcys orelxm for collation upon the oapiratim er imid le dayaad I. drat event tla wdorsdgned. jointly and novarally, age to my. late <br />fooment smite change ofli plus a reason" s tmrney's fce to be find by the noun in cam mito ormtion is inuimtod to collect the whole <br />. orpanofx' h, mmaunt.Vusmicarmy's IAf=. nneatanibyappo~sh, from "adsdionor.I.. raven. <br />SIGNED <br />BY X <br />The uderdpod agree, that F & M Towing & Auto Selvage. In. <br />"I not be held liable for damege to the above described vehicle <br />aregoilm ent. oeeumirag daeag the removal or mospert anaved by <br />the position. locationorcondilion ofthe vehicle. F & MTowiag& <br />Auto Salvage. Ins, will be held harmless by [be medenigtad Rant <br />all claims of any mdse arising from the removal of the vehicle <br />from my location, public or private. <br />INSUREDSNAME <br />SIGNATURE <br />INSURANCECO. <br />AGENT <br />I have authorized F d M TOWING & AUTO SALVAGE INC. to low my car p. and, <br />I hereby authorized my Insurance Company M Mile payment to iris towing ogency on. <br />my behalf. <br />Signature Dole. <br />OWNER <br />NAME <br />J1 <br />j=! <br />73 . a <br />