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· · · PRINT OR. TYPE . .. <br /> <br /> OFFICIAL ACCIDENT REPORT ' ' <br />A lent resulting in in'j'ury requiring medical attention o'r 'hospital'.Lsa{ion .to: or death of any person, St' total damages of <br />$$00.00 or more shall be reported by the investigating officer/operator on this form and forwarded t0 the MINNESOTA <br />DEPARTMENT OF 'NATURAL RESOURCES, Division Of Enforcement,' 500 Lafayette Road, St"Paul, MN 55155-4047 <br />within ten business days. .- <br />QUESTIONS: 1-800-766-6000 METRO 296-6137 TDD Statewide 1-800-657-3929 -TDD M'ETR~) 296-SdSd <br /> Name o(Persou or l. nvestigatmg Officer [ Telephone Number . i Department Name <br /> <br /> Acidress of Investigating Department (No. & Street, RFD, Box No., City, State, Zip Code) <br /> /.~/~'_q /d~,~/~--~/"'~,,/~. ~~'5. · <br /> <br />'Date of Accident [ '~ime ~ AM <br />~Z'- ~-~'7 z/) 9 PM <br /> <br />DeScription of Personal [njunes <br /> <br />ype 9f <br /> ualty <br /> <br />Fatal ~FataIN°n= <br /> <br />Property County <br />/{~, Damage <br /> <br />ADULT OPERATOR <br />NON MUSA AREA <br /> <br /> ~ES I DEN T <br /> <br />175 <br /> <br />Operator ~ Passenger ["---I Pedestrian <br /> <br />['~ Other (explain) _ <br /> <br />male / .Age <br /> <br /> <br />