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. • PRAIRIELAND TO�TING, INC. <br /> • � 2710 North Woodford, Decatur, Illinois 62526 <br /> CITIZEN -- TOWING CRZTIQIIE FORM <br /> (City of Decatur authorized tows only) <br /> Completely fill out this form listing dates, times and complete <br /> witness information. Turn the form into a representative of the <br /> tow company, you will receive a copy as your receipt. <br /> CIISTOMER NA�: <br /> CIISTO�:R ADDRESS: <br /> CIISTO.�R YHONE: <br /> DATED FILED: TI�: <br /> DATE OF TOW: CHARGE FOR TOW: <br /> LOCATION OF TOW: _ <br /> STATEMENT ' <br /> - Customer Signature ' <br /> DATE & TIME RECEIVED: � II <br /> RECEIVED BY: � I <br /> cc: <br /> 1-Tow Company <br /> 2-Decatur Police Departm�nt <br /> 3-Complainant - - -- - - � - -- - - - ------ <br /> ERHIBIT C <br />