Laserfiche WebLink
'A~t2.'/..~.. , PRhNT OR TYP~ ',~;~ow'mobfl~ <br /> <br /> OFFICIAL ACCIDENT REPORT ........ <br /> accident r~sulting in injury requiring medical attentiou or hospitalization to or de~th of any person, or total damages'of <br />;5C~ or more shall be reported by the investigating officer/operator on this form and forwarded to the ~fllNNESOTA <br />3E~NT OF NATURAL RESOURCES, Division Of Enforcement, $00 Eafayette Road, St. Paul, M2q 55155-4047 <br />vithin ten business days. " __ <br />~UE, STION$; 1-800-76d-5000 METRO 296-6157 TDD Statew~e 1-800-657-$929 TDD METRO 2.96-5484 <br /> <br />Name of P~rson or Inves~igaJ!~g O~cer I Tetept~one Number <br /> <br />Aaare. ss of investigating Depa.r~ment (No. & Slre~t, f~D, Box No., City, Sram, Zi~ Code) <br /> <br />[D.~artment Name <br /> <br /> Date of Accident 1 Time mM I T~e of <br /> D~cnption of Pe~onat ~lun~ <br /> <br />~er's Fuit ~ame {~'imt, Mi0dle, <br /> <br />----] x----~Non- <br /> Faml-~:::~Faml <br /> <br /> PKmPer~ I County. _ _. <br />1--'"] ~amage ''~0 ff~o~ <br /> <br />Address (No, &. Strut, RFD. Box N,-, o;,~, <br /> <br />ADULT OPERATOR <br />NON MUSA AREA <br /> <br />NON RESIDENT <br /> <br /> <br />