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N'" ~ . - PRINT OR ~ ....... ~ Snowmobile <br /> <br /> O~CI~ ACCIDE~ ~PORT <br /> An acc:dent r~ultmg m mju~ requmn~ m~ca aaenuon or hosp~t~=atmn to or dea~ of ~y person, or tot~ d~ag~ of <br /> $5~.~' or more sh~I be repo~ by ~e Mvestigating 0~cer/operatOr on ~is fo~ ~d foundS' to ~e ~N~SOTA <br /> DEP~T~ OF NA~L ~SOURCES, Divisioff 6f Enfof'cement, 5~ Lafayeae Road, St. Paul, 'MN 55155~047 <br /> wi~in ten business days. .... ' ' ' <br />~ ~UES~ONS: 1-800-76~-~000 ME~O 296-~1S7 TDD St~e~e 1-800-6S7-3929 · TDD METRO 296-~d84 <br /> Name of Pe~on or ~v~tigating'Officer ' ' { Telephone Number. ' <br /> <br /> [ Addr~s of Mvestigating DePa~nt (N0. & Strut, ~D, Box No., Ci~, S~te, Zip Cod~) . / [ <br /> <br /> Date of A~cident Time ~ ~ ~P~ 9~ ~ - ~ No~: ~ E~op~ I C°my' . ' .. <br /> , . ~_ .~ ~ I u~ual~ ' ' carol ~'Faml ~' Damage <br /> <br /> 'Deschpdon of Personal lnjun~ ' ' . <br /> <br />'O~er s F611 ~ame (First, Mid~ldj'~t) I Address {No. & Street. RFD. Box .. '.' . ' <br /> <br /> NON ~SA AREA <br /> <br /> NON ~SIDENT <br /> <br /> <br />