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APPREHENDED COPY

Republic of the Philippines


National Police Commission
PHILIPPINE NATIONAL POLICE
TARLAC POLICE PROVINCIAL OFFICE
CONCEPCION MUNICIPAL POLICE STATION
Brgy. San Jose, Concepcion, Tarlac

CONTROL NUMBER: ____________ DATE:_______________

IMPOUNDING RECEIPT
TYPE OF VEHICLE (MAKE/TYPE)
YEAR/MODEL
COLOR
PLATE NR/CONDUCTION STICKER
CHASSIS NR
ENGINE NR
DATE / TIME IMPOUNDED
MODE OF RECOVERY
VIOLATION
POSSESOR
REGISTERED OWNER
PLACE

_____________________________ _____________________________
(Signature over Printed Name) (Signature over Rank & Printed Name)
OWNER / DRIVER OF VEHICLE APPREHENDING OFFICER

STATION COPY
Republic of the Philippines
National Police Commission
PHILIPPINE NATIONAL POLICE
TARLAC POLICE PROVINCIAL OFFICE
CONCEPCION MUNICIPAL POLICE STATION
Brgy. San Jose, Concepcion, Tarlac

CONTROL NUMBER: ____________ DATE:_______________

IMPOUNDING RECEIPT
TYPE OF VEHICLE (MAKE/TYPE)
YEAR/MODEL
COLOR
PLATE NR/CONDUCTION STICKER
CHASSIS NR
ENGINE NR
DATE / TIME IMPOUNDED
MODE OF RECOVERY
VIOLATION
POSSESOR
REGISTERED OWNER
PLACE

_____________________________ _____________________________
(Signature over Printed Name) (Signature over Rank & Printed Name)
OWNER / DRIVER OF VEHICLE APPREHENDING OFFICER

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