New York > Statewide > Department Of Motor Vehicles
Request For Copy Of Accident Report MV-198C - New York
| Request For Copy Of Accident Report Form. This is a New York form and can be used in Department Of Motor Vehicles Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Use only for accidents that happen in New York State. New York State Department of Motor Vehicles MV-198C (2/11) REQUEST FOR COPY OF ACCIDENT REPORT I am the authorized representative of a person who is, or who may be, a party to a civil action arising out of the conduct described in this accident report. I am a representative of New York State or of a political subdivision of New York State, and will use this accident report ONLY for statistics or research relating to highway safety. Other reason:____________________________________ _______________________________________________ Get accident reports instantly by purchasing them on the web. Visit http://dmv.ny.gov/AIS before you use this form. Please choose one of the following: I am named in this accident report, or I am the authorized representative of a person named in this report. I am, or may be, a party to a civil action arising out of the conduct described in this accident report. Please Print Requester's Name and Address: Requester's Signature Date of Signature ± To knowingly make a false statement or conceal a material fact in this written statement is a criminal offense, punishable under Penal Law Section 210.45. Provide as much information as you can about the accident: Accident Date: ____________________________________ Accident Location (County): ____________________________________ Fatal Accident: YES NAME Address City Plate No. NAME Address City State State Date of Birth Apt. No. Zip Code Plate No. If more than 3 motorists were involved, please attach an additional MV-198C. Driver License ID No. or No. from Non-Driver ID Card Responding Police Agency: NYC Precinct # ______________ Accident #___________________ NYS Police______________________________________________ Local __________________________________________________ Plate No. NAME Address City State Driver License ID No. or No. from Non-Driver ID Card Date of Birth Apt. No. Zip Code Driver License ID No. or No. from Non-Driver ID Card Date of Birth Apt. No. Zip Code Check boxes below for all reports you are requesting: Police Report __________________________________________ Motorist Report (NAME)_________________________________ Motorist Report (NAME) ______________________________ Motorist Report (NAME) ______________________________ Mail completed form and payment to: NYSDMV, MV-198C Processing, PO Box 2086, Albany NY 12220-0086. Non-refundable search fee . . . . . . . . . . . . . . . . . . . $10.00 No. of reports requested ______ x $15 . . . . . . . . . . $ ____________ Total Amount Enclosed . . . . . . . . . . . . . . . . . . . . . . . $ ____________ Optional - Your reference number: _________________________________________ DMV USE ONLY Date:______________________________________ Transaction #: ______________________________ Operator: __________________________________ Records Found No Records Found Please select payment method (Do Not Send Cash): DMV account number Check/Money Order - Payable to Commissioner of Motor Vehicles Exempt Print name and address where the accident report(s) should be mailed: Search fee (non-refundable) . . . . . . . $10.00 No. of Reports _______ x $15 . . . . . $ ____________ Total . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________ Amount Received . . . . . . . . . . . . . . . $ ____________ $ Refund. . . . . . . . . . . . . . . . . . . . . . . . ____________ American LegalNet, Inc. www.FormsWorkFlow.com MV-198C (2/11) www.dmv.ny.gov
|
|||||||
