2. Vehicle Information
4. Year*
5. Make*
6. Model*
7. Color*
9. Vehicle Information Number (VIN):*
11. License Plate Number:*
12. License Plate State*
16. Owner Information
18. Full Name*
19. Preferred Language*
21. Address*
23. City*
24. State*
25. Zip*
26. County*
28. Phone Number*
29. Email Address*
33. Owner Consent
35. I certify that I am the lawful owner for the described vehicle and consent to the above statement.*

    1. Yes
37. I certify that I am giving consent for the vehicle to be processed by an evidence technician*

    1. Yes
39. Which of the following stickers would you like to receive in the mail?*

    1. This vehicle is tracked by Beat Auto Theft sticker (left)
    2. This vehicle is tracked by the Dayton Police Department sticker (right)
    3. Neither
41. 
42. 

44. Vehicle will not be tracked unless it is stolen and reported to police.

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field