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-01275-03 <br /> <br /> . PRINT ORTYPE <br /> <br /> accident resulting in in]jLtry requiring medical attention or 'hospitalization to or death of any person, 0r total damages of <br />100.00 or more shall be reported by the investigating officer/operator on (.his' form and forwarded to the .MINNESOTA <br />~J~EPARTMENT OF 'NATURAL RESOURCES, Division 0f Enforcement, 500 Lafayette Road, SL"Paul, MN 55155-4047 <br />~ithin ten business days. <br />IUESTIONS: 1-800-766-6000 METRO 296-6157 TDD Statewide 1-800-657-3929 -TDD METRO 296-5484 <br /> or I Telephone Number · . Name <br /> <br />~'~ddress of Investigating Department (No. & Street, RFD, Box No., City, State, zip 'Code) <br /> <br /> ate of Accident '~ime ~ T. Tjpe 9f Non- ~roperty <br /> casualty [--] Fatal ~Fatal ~ uamage <br /> <br />fescriptmn of Personal'injuries , <br /> <br />County <br /> <br />I O_.~.w~.er's Full Name (First, Middle, Last) ] Address (No. & Street. RFB'. '1~,~ u,- <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />I <br /> <br />ADULT OPERA~OR <br />NON MUSA AREA <br /> <br /> mESIDENT <br /> <br />175 <br /> <br />[--] Operator [--1 Passenger {---'] Pedestrian [-'71 Other (explain). <br /> <br /> <br />