HomeMy WebLinkAboutVDAP Right of Entry Form Application No.:_________________
(OFFICE USE ONLY)
DAV-Right of Entry Revised 8-3-2023
COUNTY OF HAWAIʻI - DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Solid Waste Division - Derelict/Abandoned Vehicle Section
345 Kekūanāoʻa Street, Suite 41 Hilo, Hawaiʻi 96720
Tel: (808) 961-8552 • Fax: (808) 961-8553 E-Mail: DEMAV@hawaiicounty.gov
www.hawaiizerowaste.org/recycle/automotive
RIGHT OF ENTRY FORM
Applicant Name: _____________________________________________________________
Property Address: ____________________________________________________________
Property Owner Name: ________________________________________________________
I/we, __________________________________ hereby authorize the County of Hawai’i,
Department of Environmental Management Abandoned Vehicle Section staff and their
designated tow service vendor, with the right of entry to my/our property located
at:______________________________________________________ for the specific purpose
of inspecting and removing a junked or derelict vehicle located on my/our property. Once the
vehicle is removed, this right of entry is nullified. I/we release the County and their designated
tow service vendor from any liability or claims on the listed property.
DO NOT sign this document until you are in the presence of a Notary Public.
Property Owner Signature: __________________________________________
STATE OF______________________)
ss:
COUNTY OF_____________________)
On this _____day of______________, 20___, before me personally appeared
_________________________, to me personally known, who, being by me duly sworn or
affirmed, did say that such person executed the foregoing instrument as the free act and deed of
such person, and if applicable, in the capacity shown, having been duly authorized to execute
such instrument in such capacity.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
__________________________________
Print Name: _________________________
Notary Public, State of ________________
My Commission Expires: _______________
[Stamp or Seal]