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Doe: defendant have any of inlury?I Ye - 'ndicaie mm?; ?may? 3
rin . ora armrest. Or elherlhe havean nnec?onto't arrest 
(If YesI complete below daia/notify -- 'u '9 . 

Explain:

. - Nameand~i=lankofw .-- -.
SLiperv'ieor Notified1..JILilo-'1.-. 

Defendants Vehicle - - .- . . - MODEL: .. . 1w: -. VIN coma?

 

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I'i'QWNEWDHIVERIDESIGNEE RELEASE Poems. oi= UABILITY 'IE?Z-?qti..--. . . axial" ?is 
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B) must read and sign diec'iaimer oi ii 3.512115 [f vehic'i?e is let: at sceneeor Show er released to 0mm a} scene.

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Owner/DriverIDesignee (me
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I Released to(Prim-?me 1 ,1 #1 I 1 State Ei 
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weer/driver/designee of the vehicle described above in consideration of coin mea?
ntioned or removed. or released ihe undersigned hereby releases and 
ploydes for any damage to, or damage caused.thef1 of or {heft irom. the vehicle

The undersigned certi?es that he/she is the iegei 
to leave the vehicle mentioned at the location rpe
Miamiaoade County and all of its agents and erh

described above . .. . . .. ..

"1 3 w. 1.1mm.

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