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You must fill out all required fields that are marked with an asterisk (*). Contact information for at least one vehicle driver/owner, to include full name, date of birth, address and phone number, must be included, or the report cannot be entered and will be discarded.
Please note for simplicity, the street on which the accident occurred will be referred to as "Street 1", and the nearest cross-street to the accident will be referred to as "Street 2". If the accident occurred in a parking lot, use the parking lot name in place of the street name. (Example: Shopko Parking Lot)
If this vehicle was unoccupied, enter 0, but you must still include registered owner/victim information in the driver fields, for the report to be entered.
Completely fill out driver and vehicle information. If this was a hit and run vehicle, enter "UNK" into all of the fields, and enter 01/01/01 for DOB.
Enter "UNK" in text fields if this is a hit and run report
Please explain in your own words what transpired leading up to, during, and after the accident. Be as factual and complete as possible. if there were more than 2 vehicles involved, include additional vehicle/driver/passenger information in the narrative.
This field is not part of the form submission.
* indicates a required field