Release of Ownership or Interest in Motor Vehicle Information

RELEASE OF OWNERSHIP OR INTEREST IN MOTOR VEHICLE VEHICLE INFORMATION
YEAR
MAKE
MODEL
COLOR
LICENSE PLATE NUMBER
LICENSE PLATE STATE
VIN/SERIAL NUMBER
TITLE NUMBER
VEHICLE - CHECK ONE

CARTRUCKPARTS ONLYOther
Vehicle Location (give directions, attach map if hard to locate)
Vehicle Owner Name
Phone
Property Owner Name
Phone
READ BEFORE SIGNING:
The undersigned, being the legal or registered owner of the vehicle described above, hereby authorizes a duly appointed agent of the Missoula County Vehicle Recycling and Disposal Program to remove the vehicle herein listed to an approved motor vehicle graveyard. In consideration of the foregoing removal, I hereby release all rights, title, and interest in the vehicle to the State of Montana and its agents without payment or compensation. To the best of my knowledge there is no lien of record against the vehicle. I agree to hold the State of Montana, the County of Missoula, and its agents harmless from any claims that may result from the release and removal of the vehicle by the program. I understand that upon release of this vehicle to a towing operator of the Vehicle Recycling and Disposal Program, there is no towing charge to me.
PLEASE ATTACH VEHICLE TITLE AND/OR REGISTRATION TO THIS FORM IF AVAILABLE.

By checking this box, the undersigned hereby requests that the vehicle herein described be disposed of only by crushing and recycling.
***NOTICE *** All garbage, wood, paper, non-vehicle material and extra tires must be removed from the vehicle prior to removal by the program. Hauler has the right to refuse any vehicle that has not been cleaned out.
VEHICLE HAS BEEN CLEANED OUT AND IS READY FOR REMOVAL
DATE

MonthDayYear
Date
PRINTED NAME
Signature

Clear
Please submit this form to our office at 301 W Alder or email to: envhealth@missoulacounty.us

Date of Pickup

Name of Hauler
Should be Empty:

RELEASE OF OWNERSHIP OR INTEREST IN MOTOR VEHICLE VEHICLE INFORMATION

READ BEFORE SIGNING:

VEHICLE HAS BEEN CLEANED OUT AND IS READY FOR REMOVAL