TIRE CONFISCATION FORM

Race #:____________ Car #:_____________ Paper #:_______________

Driver:__________________________________ Class:________________

Handler:________________________________ QMA #:______________

Address:___________________________

___________________________

Phone #: ___________________________

Signature of QMA Official:_________________________________

Signature of Handler:______________________________________

Date:_________________

TIRE CONFISCATION FORM

Race #:____________ Car #:_____________ Paper #:_______________

Driver:__________________________________ Class:________________

Handler:________________________________ QMA #:______________

Address:___________________________

___________________________

Phone #: ___________________________

Signature of QMA Official:_________________________________

Signature of Handler:______________________________________

Date:_________________

12/2008 hp