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[-~ Snowmobile <br /> <br /> ac:ident re,suiting in injury requiring medical attention or hospitxtization m or death of ~ny person, or total dmmagem of <br />fCO.(]~0r more shall be reported by the investigating officer/operator on this form and forwarded to the MINNESOTA <br />~.:-P.~M~. b~T OF MATLrRAL RESOURCES, Division of Enforcement, 500 L/fayette Road, St. Paul, MN 55155-4047 <br />,khin ten business days. <br />;UESTIONS: 1-800-766-6000 METRO 296-6157 TDD Storewide 1-800-657-3929 TDD METRO 296-5484 <br />3ama of Person or inve.mgatmg Officer I Telephone Number i Department Name <br /> Cpl. R. Kuhn I (612) 427-6812 I Ramsay PD <br /> ~,aaress of Lnvestiga£mg Department [No. & Street, Pi:D, Box No., City, State, Zip Code) <br /> <br />15153 Nowthen Blvd. Ramsay, MN 55303 <br /> <br />Data of Accident Time ~ AM T~ype .of <br /> - I ' ~ I ~sualty <br /> 12-22-96 I 21~5 ' 'P~ <br /> ! <br />~e. scnption of Personal injuries <br /> Driver sustained a leg injury :o <br /> <br /> ~-m Non- <br /> [-~ Fatal ~-'.~ Fatal <br /> <br />the knee a=aa and <br /> <br /> ~----] Property County <br /> Damage Anoka <br /> <br />could not walk - was transporued by amb. <br /> <br />......... '~,- ,', ~ ...., m~n Rnx No.. City. State, Zip Code)' <br /> <br />Age I <br /> <br />ADULT OPERATOR <br /> <br /> NON MUSA AREA <br /> <br /> NON RESIDENT <br /> <br />i 3.eg~strattoa Number hxp.o,,~ --- <br /> <br />F nSame ameas( i=t,ab Ve iddle, <br /> <br />ID.O.B. <br /> <br /> ~niut~dI .. m~l~t Age <br />~ killed xl:~ femal 3 1 <br /> <br />[":[":[":[":['~ Operator [---] Passenger [-'] Pedestrian <br /> <br />[---] Other (explain) <br /> <br />Full Name (First, Middle, Last) <br /> <br />[--'] Operator [----] Passenger [-] Pedestrian <br /> <br />Other (explain). <br /> <br />D.O.B. I [niurcdt male / <br /> <br />(Over) <br /> <br />I <br /> <br /> <br />