MOTOR VEHICLE ACCIDENT REPORT

MOTOR VEHICLE ACCIDENT REPORT

This form will be very useful to have your customers fill the vehicle's accident full report. Form Preview
MOTOR VEHICLE ACCIDENT REPORT
  • MOTOR VEHICLE ACCIDENT REPORT

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  • PERSONAL AND COMPANY VEHICLE INFORMATION

  • OWNER (DRIVER OF VEHICLE #1)

    EMPRESS AMBULANCE SERVICE 722 NEPPERHAN AVENUE, YONKERS, NY 10703
  • OTHER PERSONS PERSONAL AND VEHICLE INFORMATION

    (DRIVER OF VEHICLE #2)
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  • Section 605 (a) of the New York state Vehicle and Traffic Law every person operating a motor vehicle that is in any manner involved in an accident resulting in property damage over one thousand five hundred dollars ($1,500.00), personal injury or death, must report the accident to the Department of Motor Vehicles. If you were unable to obtain information from any other vehicle (s) involved, you only need to report your own information. MV104 forms available in the personnel office and should be mailed to: 

    NYS DEPARTMENT OF MOTOR VEHICLES

    ACCIDENT RECORDS BUREAU

    P.O. BOX 2926

    ALBANY NEW YORK, 12220-2926

  • LOCATION

  • WITNESSES:

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  • _________________________________________________________________________

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