Bishop's Property Owner Request

Wrecker Service
1111 Canal Street New Smyrna Beach, FL 32168
(386) 428-9667

This is to certify that the following vehicle or vessel was requested to be removed from a private property. Please fill this out to the best of your ability:
Year
Make*
Model*
Color*
VIN
Tag
State*
I Property Owner*
have requested that the above named vehicle or vessel be removed from the address listed above.

**In compliance with Florida State Statute 715.07

I certify that the above stated vehicle or vessel is not authorized to be on the above stated property and I wish for it to be removed.
Signature

Clear
Date

MonthDayYear
Date
Printed Name
Should be Empty: