Absentee Authorization to Release and Hold Harmless Agreement

Instructions: This form must be completed in full and notarized. Fax the completed form, along with a copy of your identification and proof of ownership, to 580-355-7787. If you have questions, call 580-355-7675.

I hereby authorize Checker Wrecker Service, 1502 SW 2nd street Lawton, OK 73501, to release the following vehicle :

_____ __________________ _______________________ _____________________________

(Year) (Make)                         (Model)                         (Vin)

Only to the following person:

___________________________________________________

(Full legal name as on state issued ID)

I certify that I am the legal registered owner as reflected by the records of the State of _________, and agree to hold harmless Checker Wrecker, its employees and officers from any legal issues that may result as the result of Checker Wrecker Service following this directive.

Signed this _______day of _________, 20___

Full Legal Name_________________________________________

State of _________________, County of________________

Subscribed and sworn to before me this ___________day of ___________, __________

My commission expires: __________________ _________________________, Notary Public