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WARNING: Your claim MUST be filed with the City of Modesto no later than six months after the date of the incident. Government Code Section 910 et. Seq.) FOR YOUR CLAIM TO BE PROCESSED: 1. You MUST accurately and completely supply all required information below. 2. You MUST state in DETAIL what damages you incurred as a result of your vehicle being towed. 3. You MUST state in DETAIL why you believe your vehicle was not properly towed. 4. Please PRINT. MODESTO POLICE DEPARTMENT TOWING CLAIM FOR MONEY OR DAMAGES TO: Modesto Police Department City of Modesto 600 10th Street P.O. Box 3313 Modesto, CA 95353 (209) 572-9679 OFFICE USE ONLY DATE RECEIVED CLAIMANT INFORMATION Name: (Last, First, Middle) Address: City: State: Zip Code: Home Phone: Work Phone: Other Phone: NOTICES TO BE SENT TO (OTHER THAN TO CLAIMANT ADDRESS) Name: (Last, First, Middle) Relation to Claimant: Address: City: State: Zip Code: Home Phone: Work Phone: Other Phone: PROVIDE INFORMATION IN DETAIL REGARDING THE CLAIM What damages and/or injury did you suffer? DESCRIBE IN DETAIL Why do you believe your vehicle was not properly towed? DESCRIBE IN DETAIL Why do you believe the City of Modesto is responsible or involved? INCIDENT INFORMATION Vehicle License Number: State Issued: Police Report Number: Signature of Claimant or Representative Date PRESENTATION OF A FALSE CLAIM IS UNLAWFUL (California Penal Code Section 72) Date of Incident: Time: Location: