31 Street, Suite A, Oklahoma City, OK 73105-4003 Attach copy of the title and approved DCAM-FORM-FM-016, if applicable General Information: Agency Name: Agency Number: Division Name: Division Number: Fleet Contact: Title / Position: Phone: Fax: E-Mail: Vehicle Assignment and Location: Vehicle Parked at: Primary State Office Field Office Home (submit Form 022), then: Driven from Home to Work, or Vehicle Parked County (name ): Shared Vehicle: Yes Work from Home City: Zip: No, employee name: Vehicle Acquisition Data: Acquired through (check one): Purchase Seizure Donation Vendor: Transfer Model Code: Purchase Amount: Purchase Order : Acquisition Meter: Acquisition Date: In Service Meter: In Service Date: Vehicle Initial Inventory Data: VIN (17 char): Tag (must attach copy of the title): Agency Vehicle : Year: Marked: Make: Yes No Color: Model: Vehicle Designation: Passenger, of seats: Body Type (check one): 2-door 3-door Drive Train Type: FWD Special Equipment: Lift Trim: Cargo Truck 4-door Extended Cab Quad/Crew Cab RWD AWD 4WD Hitch Bed Cover Other: Fuel Supply Information: Fuel Supply: OEM Converted Tank(s) Capacity: Dedicated Type: Diesel Unleaded CNG Propane Bi-Fuel Type: Flex Fuel Bi-Fuel CNG Bi-Fuel Propane Hybrid Electric Disposal /Sale Information: Date: Ending Odometer / Hour: Disposal Type (check one): DCAM/FLEET - FORM 017 (05/2014) Open Auction Amount: Consignment Sealed Bid Transfer Theft Wreck PAGE 1 OF 1.
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