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/r~me of PersOn or Investigating Officer 'Telephone Number ' <br /> ~ddr~s of ~v~tigatmg Depa~ment (No. & Str~i,' ~D~ 'Box NO., City, State, zip Code) <br /> <br />I~.ft27-q.~ PRINT OR T"FPE <br /> OFFICIAL ACCIDENT REPORT ..... <br /> accident re.suiting in injury requiring medical attention or hospitalization to or death of any person, or total damages'of <br />S500.00 or more shall be reported by the investigating officer/operator on this .form and forwarded to the MINNESOTA <br /> EthPARTMENT OF NATURAL RESOURCES, Division Of Enforcement, 500 Eafayette Road, St. Paul, MN 55155-4047 <br /> in ten business days, ' _.. <br />OUESTIONS: 1-800-766-6000 METRO 296-6157 TDD Statewide 1-800-657-3929 TDD METRO 296-5484 <br /> /~/~artment Name <br /> <br /> Date of Accident Time .qM T__.ype 9f <br /> PM <br /> criptlon of Pe~ sonal Injuries <br /> <br />~[~ ~3wner's Frill Name (First, Mid~t'li~,' I_~t) ' ' <br /> <br />I <br />I <br />I <br />I <br /> <br />I <br />I <br />I <br />I <br />! <br />I <br /> <br /> So~- <br />["'-]Fa~l~'l;a~Faml <br /> <br /> ~roperty ] County. _ <br />[---~ uamage <br /> <br />I'Address (No, & Street. RFD. g~x &la c~i,,, c .... ' ...... <br /> <br />ADULT OPERATOR <br />NON MUSA AREA <br /> <br />NON RESIDENT <br /> <br /> <br />