Instructions: Please fill out the form as completely as possible. Please complete one form for each vehicle. If you can not provide the necessary information, Vehicle Abatement staff may not be able to process your request. It is important that you include your complete name and address in the event that staff need further clarification or information regarding your request. This information will be held in the strictest of confidence.

After submission of your initial request, please feel free to contact Vehicle Abatement Unit at 408-534-2900 for general information or follow-up on the status of your case.

1. Violation Address
2. Cross Street
3. Zip Code
4. Today’s Date	7/4/2009
5. Vehicle Make	such as Toyota
6. Vehicle Model	such as Camry
7. Vehicle Color
8. Vehicle License No.
9. State of License
10. Your Name
11. Address/Zip Code
12. Home Phone
13. Work Phone
14. Email
15. Violation Occurred on Public Property:	Vehicle Parked in Excess of 72 Hours Inoperable/Disassembled Vehicle
16. Details

Revised 5/11/2007