SEIZED VEHICLE
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10 JOHNSTON COUNTY E - 911 COMMUNICATION NCIC ENTRY FORM Seized Vehicle All Fields are Mandatory Fields CASE DATA Offense Date ______________________ Seizure Date ______________________ County Charges Filed ______________________ Violation Charged ___________________ Reason for seizure Miscellaneous _____________________________________________________________________ __________________________________________________________________________________________________ ___________________________________________________________________ _______________________________ DEFENDANT DATA Name ___________________________________ Address _________________________________________ City _____________________________ State ____________ Zip ____________ Driver’s License No # State VEHICLE DATA License Number _______________________ State _________________ Vehicle Year _______________________ Model ______________ Type _________________ VIN OWNER’S DATA Registered Owner s Name ______________________________________ Address ______________________________________ City ______________________________________ State ____________ Zip ____________ Place Vehicle Stored ______________________________________ Address ______________________________________ City ______________________________________ State ____________ Zip ____________ Tel ephone Number AGEN CY DATA Seizing Officer ________________________________________ Department or Agency ________________________ Badge No _________________________________ Telephone No _________________________________ INSURANCE INFORMATION Only If Seized Vehicle Is Damaged Insurance Company _______________________________________ Address ___________________________________________________ City ____________________________ State ______________ Zip ____________ Policy No # _____________________________________________ OTHER VEHICLE S INSURANCE INFORMATION If Other Vehicl es Involved Insurance Company ____________________________________________ Address ____________________________________________ City ____________________________________________ State ____________ Zip ____________ Policy No # ____________________________________________ License Number ____________________________ State ______________ Vehicle Year ____________________________ Model ______________ Type ______________ VIN ____________________________ Information Date ___________________________ NIC # _____________________________ Officer ___________________________ Operator _____________________________Page