Speedie Recovery of South Florida, Inc.

Immobilization Request Form

Please select one:
Vehicle driven at the time of offense unless Defendant owns another vehicle registered to him/her
Any vehicle registered in the Defendant's name at the time of Impoundment or Immobilization

Vehicle Information:
Year, Make & Model:
Tag, State & Color:
Vehicle Identification Number:
City Convicted in:
County Convicted in:
Case Number:
Probation Officer:

Car Owner/Defendant Information:
First Name:
Last Name:
Address of Vehicle to be Immobilized:
City:
State:	Zip:
Home Phone:
Work Phone:

Please select the number of days the vehicle is to be immobilized for,
as orderd by the court:

Please select where the vehicle is located:

Email Address:

Submitted by:

Date:

Please type in the box the numbers and/or letters you see.
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