Maryland Motor Vehicle Accident Report PDF Template
Understanding the Maryland Motor Vehicle Accident Report form is a crucial step for anyone involved in a vehicle-related incident within the state. This comprehensive document captures a wide array of details pertaining to the accident, including basic information like the report number, accident date, and time, as well as more specific data such as the nature of the accident, whether it includes property damage (PDO), injury, or fatalities. Key sections of the form ensure thorough documentation of the incident, covering everything from the investigating officer’s details, agency area, supervising and reviewing officer IDs, to descriptions of the accident scene like road conditions, traffic signals, and the presence of hit and runs or non-traffic incidents. It also delves into particulars about the vehicles and individuals involved, including names, addresses, drivers' license numbers, vehicle registration, and insurance details. Additionally, the form indicates any citations issued, fault determinations, and detailed accounts of the accident's circumstances, which are pivotal for insurance claims and legal matters. With such comprehensive data collection, the report plays a pivotal role in the aftermath of an accident, guiding the involved parties through recovery, claim filing, and any potential legal proceedings.
Maryland Motor Vehicle Accident Report Sample
State of Maryland Motor Vehicle Accident Report
REPORT NO. |
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1 |
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PAGE OF |
ACCIDENT DATE |
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3 |
ACCIDENT TIME 4 |
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REPORT TYPE |
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5 |
RESEARCH |
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LOCAL CASE NUMBER |
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LOCAL CODES |
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PHOTOS ? |
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510345 |
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FATAL |
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INJURY |
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PDO |
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NO |
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2 6 |
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0 4 |
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7 |
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HIT & RUN |
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YES |
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INVESTIGATING OFFICER ID |
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10 |
AGENCY AND AREA |
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SUPERVISING OFFICER ID |
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12 |
REVIEWER ID # |
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13 |
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CODE - AND - NAME OF MUNICIPALITY |
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COUNTY |
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15 |
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Albert Green |
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2397 |
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J |
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E |
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0 |
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1 |
Linda Williams |
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c99 |
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Brad Linquist |
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j45 |
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0 0 |
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Annapolis |
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0 2 |
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RD CHAR |
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RTE NUM Accident Occurred On |
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17 |
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ROAD NAME |
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18 |
IN LANE |
TRAF SIG |
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ON RAMP |
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Ramp Number (Direction) |
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IN INTERSECTION |
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19 |
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NO 20 |
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NO |
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NO |
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23 |
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0 |
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2 |
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U S |
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9 |
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7 |
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N 2 |
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YES |
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YES |
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5 |
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6 |
7 |
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8 |
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9 Other |
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YES |
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RD COND |
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25 |
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INTERSECTING ROAD NAME or Log Mile Reference Manual description. |
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26 |
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MILEPT |
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27 |
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DIR |
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Dist. of Acc fr |
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29 |
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0 1 |
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M |
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1 |
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28 |
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6 |
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Ft |
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N |
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Mi |
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RD DIV |
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ACCIDENT |
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Show & Label: Roads, Traffic Units, the Travel Direction |
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DESCRIBE ACCIDENT briefly: identify units by numbers. Also identify the following |
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33 |
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30 |
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DIAGRAM |
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consistent with the Log Mile Reference Manual, and Movement |
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a) the OBJECT DAMAGED & NATURE OF DAMAGE (Property other than vehicles) and |
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0 |
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of Traffic Units. |
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b) the NAME & ADDRESS OF OWNER when applicable. |
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SRF COND |
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Veh1 was going northbound when a deer entered the roadway. Veh1 slowed to avoid |
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the deer as it ran across the road. Veh2, speeding, was unable to brake in time and |
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C/M ZONE |
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NO |
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YES |
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||||
JUNCT'N |
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|||||
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36 |
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0 |
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0 |
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EVENT - 1 |
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37 |
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0 |
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1 |
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EVENT - 2 |
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|||
0 |
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0 |
38 |
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||
FIX OBJ |
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|||
0 |
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5 |
39 |
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||
COLL |
|
TY |
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|||
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40 |
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0 |
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3 |
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LIGHT |
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41 |
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0 |
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1 |
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WEATHER |
|
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|||
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42 |
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0 |
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3 |
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UNIT # |
43 |
|
NAME |
|
(First, |
Middle, |
|
|
Last) |
|
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|
44 |
|
SEX |
45 |
UNIT # |
43 |
NAME |
(First, |
Middle, |
Last) |
|
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44 |
|
SEX |
45 |
||||||||||||||||||||||||||||||||||||||||
0 |
|
|
1 |
|
|
|
Brandy |
|
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|
E |
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|
Orr |
|
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0 |
|
2 |
0 2 |
|
|
Walter |
|
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|
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|
O |
|
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|
Joseph |
|
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0 |
|
|
1 |
|||||||||||||||||||||||||||||
TYPE |
|
|
46 |
|
ADDRESS (No., |
|
Street, City, State, Zip) |
|
|
|
|
|
|
|
|
|
|
|
|
TEL |
Work |
|
|
|
Res |
|
|
|
47 |
|
INJ |
48 |
TYPE |
46 |
ADDRESS |
(No., Street, City, State, |
Zip) |
|
|
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|
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|
|
TEL |
|
|
Work |
|
|
|
Res |
|
|
|
|
47 |
|
INJ |
48 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OF |
|
|
|
4602 Oldham St |
|
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|
6 4 1 6 1 9 2 0 6 5 |
|
0 2 |
OF |
|
|
4676 Everett St |
|
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|
5 4 0 4 5 8 4 6 7 6 |
|
0 |
3 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
UNIT |
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UNIT |
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|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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|
EMS |
49 |
|
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|
|
EMS |
49 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DRIVER |
|
Annapolis |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MD |
24744 |
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
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|
|
DRIVER |
Annapolis |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MD |
84381 |
|
|
|
|
|
|
|
|
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|
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|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
"PED" |
|
|
|
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|
|
|
|
0 |
|
"PED" |
|
|
|
|
|
|
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|
|
|
|
A |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MOVEMENT |
|
CONDITN |
|
|
SUBST |
|
|
TEST |
|
RESULT |
|
|
|
FOR |
|
|
|
|
AGE |
|
|
|
|
|
TYPE |
LOCAT'N |
|
OBEY |
|
|
|
VISIBL |
|
MOVEMENT |
CONDITN |
SUBST |
|
TEST |
|
|
|
|
RESULT |
|
|
FOR |
|
|
|
|
AGE |
|
|
|
|
|
|
TYPE |
LOCAT'N |
OBEY |
|
|
VISIBL |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
0 |
|
|
3 |
50 |
|
0 |
|
|
51 |
|
|
0 |
|
52 |
0 |
53 |
|
|
|
|
54 |
PEDS |
|
|
|
|
|
|
|
|
55 |
|
|
56 |
|
57 |
|
|
|
|
58 |
|
|
|
|
59 |
0 |
3 |
50 |
0 |
|
|
|
51 |
|
0 |
|
52 |
|
0 |
|
|
53 |
|
|
|
|
54 |
|
PEDS |
|
|
|
|
|
|
|
|
|
55 |
|
56 |
|
|
57 |
|
|
|
|
58 |
|
|
|
59 |
|||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
1 |
|
|
|
1 |
|
0 |
|
|
|
|
|
|
|
ONLY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
1 |
|
|
|
0 |
|
|
|
|
|
|
|
|
|
ONLY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||
SPEED LIMIT |
|
SAF. EQU |
|
EQ PROB |
|
|
EJECT |
|
CITATION NUMBER (S) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
64 |
|
FAULT |
|
SPEED LIMIT |
SAF. EQU |
EQ PROB |
|
EJECT |
|
CITATION NUMBER (S) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
64 |
|
FAULT |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
60 |
|
|
|
|
61 |
|
|
|
|
|
62 |
|
|
|
|
63 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NO 65 |
|
|
|
60 |
|
|
|
|
61 |
|
|
|
62 |
|
|
|
|
|
63 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NO 65 |
||||||||||||||
5 |
|
|
0 |
|
|
|
1 |
|
|
1 |
|
|
1 |
|
3 |
0 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YES |
5 |
0 |
|
|
1 |
|
|
|
3 |
|
0 |
|
1 |
|
0 |
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YES |
||||||||||||||||||
GOING |
|
|
|
DRIVER'S LICENSE NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
STATE |
|
CLASS |
GOING |
|
|
DRIVER'S LICENSE NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
STATE |
|
CLASS |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
66 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67 |
|
|
|
|
68 |
|
|
|
|
69 |
|
|
|
66 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67 |
|
|
|
|
68 |
|
|
|
69 |
|||||||||||||
0 |
|
|
1 |
|
|
|
429945408 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
M D |
|
3 |
|
|
|
0 1 |
|
|
331481440 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
M D |
|
2 |
|
|
|
||||||||||||||||||||||||||||
CONTINU |
|
DR DATE OF BIRTH |
71 |
|
IRREGULAR CONDITION |
72 |
|
HM SPILL |
|
HAZ MAT NUMBER |
|
CONTINU |
DR DATE OF BIRTH |
|
|
|
|
71 |
|
IRREGULAR CONDITION |
72 |
|
|
HM SPILL |
HAZ MAT NUMBER |
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
70 |
|
|
|
|
|
|
|
|
|
|
|
|
|
1 |
9 |
|
|
PARKED |
|
|
|
|
|
CAUGHT FIRE |
|
|
73 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
74 |
|
|
|
70 |
|
|
|
|
|
|
|
|
|
|
1 |
|
|
9 |
|
|
|
PARKED |
|
|
|
|
|
|
CAUGHT FIRE |
|
|
|
|
73 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
74 |
|||||||||||||||||||||||||||||||||||||||||||||||
0 |
|
|
1 |
|
|
|
0 |
|
|
9 |
|
|
2 |
|
0 |
4 |
|
1 |
|
|
HIT & RUN |
DRIVERLESS |
|
N |
Y |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0 |
4 |
|
|
0 |
|
|
8 |
|
1 |
|
7 |
|
4 |
|
|
2 |
|
|
|
HIT & RUN |
|
DRIVERLESS |
|
|
|
N |
|
|
Y |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||
BODY TY |
|
COMMER. |
|
|
|
U. S. DOT NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
ICC NUMBER |
|
|
|
|
|
|
|
|
BODY TY |
CDL? |
|
BODY TY |
COMMER. |
|
|
U. S. DOT NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ICC NUMBER |
|
|
|
|
|
|
|
|
|
BODY TY |
CDL? |
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
75 |
|
VEHICLE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
77 |
|
|
78 |
|
|
|
NO |
79 |
|
|
|
75 |
VEHICLE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
77 |
|
|
78 |
|
|
|
NO |
79 |
|||||||||||||||||||||||||||||||||
0 |
|
|
2 |
|
|
|
ONLY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YES |
|
0 |
2 |
|
|
ONLY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YES |
|||||||||||||||
MOST HE |
|
OWNER OR CARRIER NAME (Write "SAME" if Driver) |
|
|
|
|
|
|
|
|
TEL |
Work |
|
|
|
Res |
|
|
|
|
|
|
|
|
|
|
MOST HE |
OWNER OR CARRIER NAME (Write "SAME" if Driver) |
|
|
|
|
|
|
|
|
|
|
TEL |
|
|
Work |
|
|
|
Res |
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
80 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81 |
|
|
|
80 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81 |
||||
0 |
|
|
1 |
|
|
|
Same |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0 |
1 |
|
|
Bryan |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
H |
|
|
|
|
|
|
|
|
|
O'Neil |
|
|
|
|
|
|
|
|
|
|
|
3 5 2 7 8 4 3 8 7 1 |
|||||||||||||||||||||||||||||||||||
CONTRIB |
|
OWNER / CARRIER ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
CONTRIB |
OWNER / CARRIER ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||
CIRCUM- |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
83 |
CIRCUM- |
3119 Brighton Ave |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
83 |
||||||||||||||||||||||||||||
STANCES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
STANCES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOWED VEH (S) |
|
|
|
|
84 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOWED VEH (S) |
|
|
|
|
84 |
|||||||||||||||||||||||||||||
4 |
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 8 |
|
|
Annapolis |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MD 47344 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||||||
|
|
|
|
YEAR & MAKE OF VEHICLE |
|
|
|
|
|
|
|
|
|
|
|
|
|
MODEL |
|
|
|
|
|
|
|
|
|
|
1st IMPACT PT. |
87 |
|
1 |
|
|
0 |
|
YEAR & MAKE OF VEHICLE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MODEL |
|
|
|
|
|
|
|
|
|
|
|
1st IMPACT PT. 87 |
|
0 |
1 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
85 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
86 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
85 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
86 |
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||
2 |
|
|
6 |
|
|
|
8 |
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
FORD |
|
|
|
|
|
|
|
|
|
|
Tempo |
|
|
|
|
|
|
|
|
|
|
MAIN IMPACT |
88 |
|
0 |
|
|
9 |
2 1 |
|
|
0 4 |
|
|
|
|
TOYT |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Matrix |
|
|
|
|
|
|
|
|
|
|
|
MAIN IMPACT |
88 |
|
0 |
2 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||
|
|
|
|
EXP YR & REGISTR # STATE |
|
|
|
|
|
AREAS DAMAGED |
|
|
|
|
|
|
INSURER |
|
|
|
|
|
|
|
|
|
|
|
EXP YR & REGISTR # STATE |
|
|
|
|
|
|
AREAS DAMAGED |
|
|
|
|
|
|
|
INSURER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
89 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
89 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91 |
||||||||
|
|
|
|
|
|
|
0 |
|
|
5 |
|
|
WGQ 562 |
|
|
|
|
M D |
|
0 |
9 |
|
1 |
0 |
|
0 |
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 2 |
|
|
0 8 |
MZZ 539 |
|
|
|
|
M D |
1 |
5 |
|
1 |
7 |
|
1 |
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
VEHICLE ID NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
POLICY NUMBER |
|
|
|
|
|
|
|
|
|
|
|
VEHICLE ID NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
POLICY NUMBER |
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
92 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
93 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
92 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
93 |
||||||
|
|
|
|
|
|
|
21427BEW 770WMS 731 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
50452VKW 299SFL 391 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||||||||||||||||||||||||
DAM EXT |
|
VEHICLE REMOVED BY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VEHICLE REMOVED TO |
|
|
|
|
|
DAM EXT |
VEHICLE REMOVED BY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VEHICLE REMOVED TO |
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
94 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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95 |
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96 |
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94 |
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95 |
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96 |
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TRAFFIC |
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SEATING |
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CODE all injured & uninjured PASSENGERS below. Use "W" for witness in TRAF UNIT and SEAT columns. |
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SAFETY |
EQUIP |
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INJUR |
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EJEC- |
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UNIT # |
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WRITE NAME & ADDRESS of Injured Passengers and Witnesses. |
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Witness telephone #. |
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SEX |
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PROB. |
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97 |
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98 |
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99 |
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100 |
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101 |
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104 |
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105 |
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106 |
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Eric |
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G |
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Crosby |
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3448 Lillibridge St |
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Annapolis |
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MD 60665 |
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1 4 8 9 5 8 5 6 8 1 |
0 1 |
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0 |
2 |
6 |
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1 1 |
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0 1 |
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Gavin |
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K |
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Sakic |
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2678 Brookview Dr |
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Annapolis |
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MD 15424 |
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2 7 9 8 0 4 1 2 9 6 |
0 1 |
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Elaine |
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Geller |
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3636 Monterey Dr |
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Annapolis |
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MD 38364 |
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6 4 0 8 1 9 5 2 1 6 |
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Penny |
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Manning |
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2638 S 55th St |
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Annapolis |
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MD 50596 |
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4 8 6 3 8 1 6 9 8 3 |
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8 |
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1 1 |
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Harold |
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Mason |
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4946 Valley Rd |
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Annapolis |
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MD 62828 |
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3 3 3 8 4 2 2 1 4 0 |
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6 |
7 |
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1 3 |
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3 |
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Ross |
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U |
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Williams |
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2753 Brighton Ave |
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Annapolis |
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MD 52732 |
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1 7 9 6 4 3 3 9 0 7 |
0 1 |
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4 |
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1 4 |
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1 3 |
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E UNIT |
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INJURED TAKEN BY: |
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INJURED TAKEN TO: |
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EMS RUN REPORT # |
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E UNIT |
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INJURED TAKEN BY: |
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INJURED TAKEN TO: |
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EMS RUN REPORT # |
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M |
107 |
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EmergyStat |
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108 |
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Annapolis General |
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109 |
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110 |
M |
107 |
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108 |
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109 |
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110 |
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S A |
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S |
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||||||||||||||||||||||||||||||||||||
MSP FORM #1 |
(3/95) |
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MSP - CENTRAL RECORDS DIVISION COPY
File Breakdown
| Fact Name | Description |
|---|---|
| Form Title | State of Maryland Motor Vehicle Accident Report |
| Governing Body | Maryland State Police - Central Records Division |
| Form Identifier | MSP Form #1 |
| Investigating Agencies | Local and state law enforcement agencies |
| Key Sections | Accident Information, Investigating Officer ID, Driver Information, Vehicle Information, Diagram and Description of the Accident |
| Special Considerations | Includes sections for Non-Traffic and Hit & Run incidents |
| Usage Mandatory | For all accidents occurring within Maryland that involve injury or significant property damage |
| Submission Guidelines | Must be completed and submitted by the investigating officer as soon as possible after the accident |
Steps to Filling Out Maryland Motor Vehicle Accident Report
When involved in a motor vehicle accident in Maryland, completing the Maryland Motor Vehicle Accident Report form is a critical step in documenting the incident. This form is instrumental for insurance claims, legal proceedings, and personal records. Proper completion of this form ensures that all aspects of the accident are recorded accurately, including details about the drivers, vehicles, and circumstances surrounding the accident. The steps outlined below serve as a guide to fill out the form comprehensively.
- Start by entering the Report Number in the designated field at the top of the form.
- Fill in "Page of" to indicate if additional pages are attached.
- Record the Accident Date and Accident Time, ensuring accuracy for official records.
- Specify the Report Type by checking the appropriate box related to the nature of the accident.
- Indicate if the report is for research purposes by marking the Research box as required.
- Enter the Local Case Number, which is the reference number provided by the reporting police agency.
- Document any Local Codes that apply to the accident report.
- Mark the Photos? box to indicate whether photographs of the accident scene are available.
- Check the appropriate boxes under Fatal, Injury, PDO (Property Damage Only) to classify the accident based on impact.
- Fill in details regarding the Hit & Run and Non-Traffic aspects if applicable.
- Enter the Investigating Officer ID, Agency and Area, Supervising Officer ID, and Reviewer ID #.
- Document the Code and Name of Municipality and County where the accident took place.
- Describe the exact location using Road Name, Intersection, Ramp information, and Direction from the intersection.
- Provide specific details of the accident under Describe Accident, including a brief narrative and a diagram if necessary. Ensure to also include information about any damaged property and the owner if applicable.
- Complete the sections relating to Weather, Light, Road Conditions, and any other environmental factors contributing to the accident.
- Detail information about each vehicle and pedestrian involved, including their Names, Addresses, Vehicle Types, and Conditions at the time of the accident.
- For each driver, enter their Driver's License Number, State, and Class; also, document any citations issued at the scene.
- Record any Irregular Conditions, Hazardous Material Spills, or other noteworthy circumstances.
- For commercial vehicles, provide the U.S. DOT Number and ICC Number if applicable.
- List the Owner or Carrier Name and address for any commercial vehicles involved.
- Document towing information, if any vehicles were towed from the scene.
- Detail injuries, the use of safety equipment, and any ejections from vehicles.
- Provide information about passengers, witnesses, and any EMS involvement, including the destination hospital and EMS run report number.
Once completed, the form should be reviewed for accuracy and completeness before submission to the appropriate Maryland state authorities. Timely and accurate completion of this form plays a critical role in the aftermath of a motor vehicle accident by ensuring a well-documented record is available for all parties involved.
More About Maryland Motor Vehicle Accident Report
What is the Maryland Motor Vehicle Accident Report form?
The Maryland Motor Vehicle Accident Report form is a document used by law enforcement to record details of traffic accidents that occur in the state of Maryland. It includes information about the vehicles, drivers, passengers, accident scene, and circumstances surrounding the accident.
When should the Maryland Motor Vehicle Accident Report form be filled out?
This form should be completed at the time of a motor vehicle accident by the investigating officer who responds to the scene. It’s filled out for accidents that result in injury, death, or significant property damage.
What information is required on this form?
The form requires various details, including:
- Accident location and time
- Information about the vehicles and drivers involved
- Details of the accident circumstances and conditions
- Information on passengers, injuries, and witnesses
- Details of vehicle damage and property damage, if applicable
Can I submit the Maryland Motor Vehicle Accident Report form online?
Currently, the Maryland Motor Vehicle Accident Report form must be submitted by the investigating officer or agency. Individuals involved in the accident can request a copy from the relevant law enforcement agency or through the Maryland Central Records Division, but submission by the public online is not available.
Is there a deadline for filing this report?
Yes, law enforcement officers are required to submit the completed form to the Central Records Division within a specified timeframe, typically within a few days after the accident investigation is concluded.
What happens if the accident details are inaccurately reported?
If inaccuracies are found in the accident report, individuals involved in the accident can request a correction by submitting supporting documentation to the law enforcement agency that filed the report or to the Maryland Central Records Division. It's crucial to provide clear evidence to support any claim of inaccuracies.
How can I obtain a copy of an accident report?
Individuals involved can request a copy of the accident report through:
- The law enforcement agency that investigated the accident
- The Maryland Central Records Division, by submitting a request form along with the required fee
Why is it important to fill out the Maryland Motor Vehicle Accident Report form accurately?
Accurate completion of the form is essential for several reasons:
- It provides a legal record of the accident, which is crucial for insurance claims and legal proceedings.
- It helps law enforcement and transportation agencies to identify and address safety issues on roadways.
- It ensures that all parties involved have access to accurate information for resolving disputes, claims, and for personal records.
Common mistakes
Filling out the Maryland Motor Vehicle Accident Report form requires attention to detail. Often, people make common mistakes that can affect the accuracy and reliability of the report. Here are five of those frequent errors:
Not providing complete information about the accident location: It is crucial to detail the accident's exact location, including road names, intersection, direction, and any relevant mile points. Incomplete information can lead to delays in processing the report.
Failing to accurately describe the accident: A clear and concise description of how the accident occurred is necessary. This includes identifying all involved parties, the direction of travel, and actions leading up to the collision. Vague descriptions can complicate understanding the dynamics of the incident.
Omitting details about road and weather conditions: The conditions of the road and weather at the time of the accident can significantly influence its cause and severity. Neglecting to include this information can overlook critical contributing factors.
Incorrectly documenting vehicle and driver information: Every detail about the involved vehicles and drivers, such as license numbers, insurance information, and contact details, must be recorded accurately. Mistakes in this area can hinder further investigation and resolution of the incident.
Skipping witness information: If there were witnesses to the accident, their accounts could be invaluable. Failing to include witness names, contact information, and statements might result in the loss of key pieces of evidence.
Avoiding these mistakes can greatly improve the quality and usefulness of an accident report. It ensures that all parties involved have a clear understanding of the incident, which aids in the resolution process.
Documents used along the form
When individuals find themselves involved in a vehicle collision in Maryland, the completion of a Maryland Motor Vehicle Accident Report form marks just the beginning of a series of documentation and formalities required. This form, essential for capturing the specifics of the incident, is often accompanied by several other critical documents, each serving a unique purpose in the broader context of post-accident procedures. Understanding these accompanying documents can considerably ease the navigation through the often-complex aftermath of a road accident.
- Insurance Claim Forms: These are provided by the involved parties' insurance companies and are critical for initiating the claims process. They require detailed information regarding the accident and the damages incurred.
- Medical Records: In the event of injuries, comprehensive medical records are necessary to document the nature and extent of the injuries for insurance claims and potential legal proceedings.
- Vehicle Repair Estimates: These documents, prepared by auto repair shops, outline the estimated cost of repairing the damage to the vehicles involved in the accident.
- Witness Statements: Written accounts from witnesses can provide additional perspectives on the accident, often proving invaluable for insurance claims and legal disputes.
- Police Report: A formal police report provides an authoritative record of the accident and includes the investigating officer's observations and conclusions. It often plays a crucial role in determining fault.
- Photographic Evidence: Photos taken at the scene can document the damage to vehicles, road conditions, and other relevant details that reports might not capture fully.
- Traffic Citations: If traffic laws were violated, citations can affect the determination of fault and may impact insurance claims and legal proceedings.
- Property Damage Documentation: If there is damage to property other than the vehicles involved, documents detailing the nature and cost of repairs are necessary for insurance and compensation purposes.
Navigating the aftermath of a vehicle accident in Maryland, with its requisite paperwork and procedures, can be a daunting task. However, understanding the role and importance of each document related to the Maryland Motor Vehicle Accident Report form can simplify this process. Equipped with the right information and documents, individuals can more effectively manage the situation, whether it involves insurance claims, legal action, or both. This underscores the broader principle that, in the legal arena, thorough documentation forms the backbone of any case or claim arising from such incidents.
Similar forms
The Maryland Motor Vehicle Accident Report form is similar to other documents used for reporting incidents. Among these, the Police Traffic Accident Report stands out for its comprehensive nature, capturing various details about an accident scene. Both reports collect extensive data on the accident's specifics, such as the time and date, location, involved parties, vehicle descriptions, and a diagram of the accident scene. This ensures that all relevant information is documented systematically for legal, insurance, and statistical purposes.
Another document it closely resembles is the Insurance Claim Form. While the primary purpose of an insurance claim form is to initiate the claims process with an insurance company, it also gathers detailed information about the accident, including the extent of damage and personal injuries. Similar sections in both forms include details about the drivers, vehicles involved, and a description of the accident. This parallel design facilitates the exchange of essential information between law enforcement agencies and insurance companies, streamlining the claims process for those affected.
The form also shares characteristics with the Department of Motor Vehicles (DMV) Accident Report. States often require drivers involved in significant accidents to file a report with their DMV. Both the Maryland report and DMV forms typically require information on the accident's date, time, location, parties involved, and a brief narrative or diagram of how the accident occurred. The key aim is to keep an official record of the incident, which can be used for legal purposes and to help identify hazardous road conditions that may require attention.
Dos and Don'ts
When engaging with the Maryland Motor Vehicle Accident Report form, it's critical to handle the process with accuracy and clarity to ensure all information is correctly recorded. The following are dos and don'ts to consider:
Do:- Ensure all information is correct and up-to-date, such as personal details, accident specifics, and any other required information on the form.
- Provide a detailed and clear description of the accident in the designated section to ensure that the sequence of events is easy to understand.
- Include all relevant information regarding damage to property other than vehicles and the names and addresses of the owners if applicable.
- Review your report carefully before submitting it to spot any errors or o myissions that could impact the accuracy of the record.
- Leave sections blank unless they truly do not apply to your situation; if unsure, consulting with an official or seeking guidance can prevent gaps in information.
- Guess or approximate details about the accident; if certain specifics are unknown, it's better to clarify this than to provide potentially incorrect information.
- Forget to report all injuries, regardless of their severity, as all physical impacts should be recorded for an accurate representation of the incident's outcome.
- Rush through filling out the form; taking your time can ensure thoroughness and precision, which are key in legal and insurance contexts.
Misconceptions
When it comes to understanding the Maryland Motor Vehicle Accident Report form, several misconceptions commonly arise. It's essential to clarify these to ensure accurate reporting and comprehension of how the process works following a vehicle accident in Maryland.
Misconception: Every traffic incident requires a Maryland Motor Vehicle Accident Report form.
Reality: Not all traffic incidents require filing this report. Typically, it's necessary for accidents resulting in significant property damage, injuries, or fatalities. Minor fender-benders without injuries may not necessitate a complete report.
Misconception: The report can only be filed by a law enforcement officer.
Reality: While law enforcement officers often complete this report at the accident scene, individuals involved in the accident can also file a report, especially if the police do not attend the incident.
Misconception: The report must be filed immediately at the scene of the accident.
Reality: Although timely filing is crucial, the report does not need to be completed at the accident scene. There's a window of time after the incident to submit the report, allowing for the collection of necessary information and details.
Misconception: If you're not at fault, you don't need to file a report.
Reality: Regardless of fault, it's wise for all parties involved in an accident to file a report. This document serves as an official record and can be crucial for insurance claims and legal purposes.
Misconception: The accident report will determine who is legally at fault for the accident.
Reality: The report provides an official account of the incident but does not establish legal fault. Fault determinations are typically made by insurance companies or through legal proceedings.
Misconception: All sections of the report must be filled out for it to be accepted.
Reality: While it's important to provide complete and accurate information, some sections of the report may not apply to every accident and can be left blank if they're not relevant.
Misconception: Personal information disclosed in the report is available to the public.
Reality: While the report is an official document, sensitive personal information is protected and not indiscriminately released to the public, adhering to privacy laws and regulations.
Misconception: Submitting a Maryland Motor Vehicle Accident Report form will automatically increase your insurance premiums.
Reality: Filing a report does not directly impact your insurance premiums. Factors influencing rate changes include the nature of the accident, the determination of fault, and individual insurance policy terms.
Clearing up these misconceptions helps in understanding the purpose and process of the Maryland Motor Vehicle Accident Report form, ensuring that individuals can navigate the aftermath of an accident more effectively.
Key takeaways
Filling out the Maryland Motor Vehicle Accident Report form accurately and comprehensively is critical for several reasons. It serves as a legal document that can impact insurance claims, fault determinations, and even legal proceedings following an accident. Here are four key takeaways about filling out and using this form:
- Accuracy is paramount. Every detail on the form should be filled out with the utmost accuracy. This includes correct dates, times, locations, and specific details about the accident circumstances. Mistakes or inaccuracies could lead to complications or disputes later on, especially when it comes to insurance claims or legal matters.
- Details matter. The form requires specific information about the accident, including the direction of travel, road conditions, weather conditions, and more. Providing a thorough description, including a diagram of the accident, can significantly help in understanding what happened. This level of detail is particularly important for law enforcement and insurance investigators to accurately assess the situation.
- Report all injuries and damages. Even seemingly minor injuries or damages should be documented on the report. This is because some injuries or damages might not become apparent until after the accident, and having a record that they occurred is crucial. Additionally, listing all parties involved, whether they are drivers, passengers, or pedestrians, ensures a comprehensive record of the event.
- Use of the form in legal and insurance matters. The completed form is a vital document for insurance claims, serving as a basis for determining fault and liability. It might also be used in legal proceedings should there be disputes regarding the accident. Hence, the importance of the form extends far beyond the immediate aftermath of the accident, highlighting the need for careful and detailed completion.
Understanding and adhering to these key points when filling out the Maryland Motor Vehicle Accident Report form can help ensure that all involved parties have a clear, accurate, and fair account of the incident, thereby facilitating a smoother resolution process.
Common PDF Templates
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