DUI Immobilization Request Form Please Select One Vehicle driven at the time of offense unless Defendant owns another vehicle registered to him/her. Any vehicle registered in the Defendant's name at the time of Impoundment or Immobilization Vehicle Information: Year, Make and Model: Vehicle Information: Tag, State and Color: Vehicle Identification Number: County And Case Number: Car Owner/Defendant Information: First Name Last Name Home Phone - Area Code Phone Number Mobile Number - Area Code Phone Number Work Phone - Area Code Phone Number Best Contact Number And Time To Reach You At: Please select the number of days the vehicle is to be immobilized for, as ordered by the court: 10 Days 30 Days 60 Days Please select where the vehicle is located at NOW: St Lucie County Palm Beach County Martin County Indian River County NOTE: If vehicle located in a development, what is the name of the development. For example: The Oaks, Bicycle Club, Weston Breezes, etc. If vehicle is NOT located in a development please leave blank. Street Address City State Zip Code E-mail Name of the person requesting This DUI Immobilization. First Name Last Name Date - Month - Day Year Time 1 2 3 4 5 6 7 8 9 10 11 12 : Hour 00 10 20 30 40 50 Minutes AM PM Submit Should be Empty:
