Blank Maryland Motor Vehicle Accident Report PDF Form

Blank Maryland Motor Vehicle Accident Report PDF Form

The Maryland Motor Vehicle Accident Report form is a crucial document used to record the details of vehicle accidents that occur within the state. This report not only helps law enforcement agencies gather necessary information but also assists in insurance claims and legal proceedings following an accident. If you’ve been involved in an accident, it’s important to fill out this form accurately—click the button below to get started!

The Maryland Motor Vehicle Accident Report form serves as a crucial document for recording the details of accidents that occur on the state’s roads. This comprehensive form includes essential information such as the date and time of the accident, the type of report being filed, and specific identifiers like the local case number and investigating officer's ID. It captures the nature of the accident, whether it resulted in fatalities, injuries, or property damage, and provides a space for diagrams illustrating the scene. The form also collects data on the vehicles involved, including their make, model, and registration details, alongside information about the drivers and any passengers. Additionally, it allows for the documentation of weather conditions, road conditions, and traffic signals at the time of the incident. Each section is designed to ensure that all relevant facts are recorded, facilitating a thorough investigation and providing valuable insights for insurance claims and legal proceedings. Understanding how to properly complete this form can significantly aid those involved in an accident, ensuring that their experiences and circumstances are accurately represented.

Document Sample

State of Maryland Motor Vehicle Accident Report

REPORT NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

PAGE OF

ACCIDENT DATE

 

 

 

 

3

ACCIDENT TIME 4

 

REPORT TYPE

 

 

 

 

 

 

 

 

5

RESEARCH

 

 

 

 

 

 

 

6

 

LOCAL CASE NUMBER

7

LOCAL CODES

8

PHOTOS ?

510345

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FATAL

 

INJURY

 

 

PDO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

1

1

 

 

1

 

2 6

 

 

0 4

1

 

0

0

 

7

 

 

 

 

HIT & RUN NON-TRAFFIC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2005-040123

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

INVESTIGATING OFFICER ID

 

 

 

 

 

 

 

 

 

 

 

10

AGENCY AND AREA

11

SUPERVISING OFFICER ID

 

 

 

 

12

REVIEWER ID #

 

 

 

 

 

 

 

 

 

 

 

13

 

CODE - AND - NAME OF MUNICIPALITY

14

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15

Albert Green

 

 

 

 

 

 

2397

 

 

 

 

 

 

 

J

 

 

E

 

 

 

 

 

 

0

 

1

Linda Williams

 

 

 

 

c99

 

 

 

 

Brad Linquist

 

 

 

 

 

 

j45

 

 

 

0 0

3

 

Annapolis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RD CHAR

 

RTE NUM Accident Occurred On

 

 

17

 

ROAD NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18

IN LANE

TRAF SIG

 

ON RAMP

0

 

Ramp Number (Direction)

 

 

0-Not Ramp

IN INTERSECTION

 

 

 

 

16

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19

 

NO 20

 

 

 

 

NO

21

 

 

 

 

1 N-W

2 W-N 3 E-N 4 N-E

22

 

NO

 

 

23

0

 

 

2

 

 

 

U S

 

 

9

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N 2

 

 

YES

 

 

 

 

YES

 

 

 

5 S-E

 

6 E-S

7 W-S

 

 

 

8 S-W

 

 

9 Other

 

 

 

 

 

 

YES

 

 

 

 

 

RD COND

 

INT-RTE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25

 

INTERSECTING ROAD NAME or Log Mile Reference Manual description.

 

 

 

 

 

 

 

 

 

 

26

 

MILEPT

 

 

 

 

 

 

 

 

 

 

 

 

 

27

 

DIR

 

Dist. of Acc fr INT-RTE/Ref. & Dir.

 

 

 

 

29

0 1

24

 

M

 

 

D

 

3

 

0

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28

 

 

 

 

 

0

0

6

 

 

 

 

 

 

 

 

 

 

 

Ft

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mi

 

 

RD DIV

 

 

 

 

 

 

 

 

ACCIDENT

 

 

 

 

Show & Label: Roads, Traffic Units, the Travel Direction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE ACCIDENT briefly: identify units by numbers. Also identify the following

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

 

 

 

 

30

 

 

 

 

 

 

DIAGRAM

 

 

 

 

consistent with the Log Mile Reference Manual, and Movement

 

 

 

 

 

 

 

 

 

 

a) the OBJECT DAMAGED & NATURE OF DAMAGE (Property other than vehicles) and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of Traffic Units.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b) the NAME & ADDRESS OF OWNER when applicable.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SRF COND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Veh1 was going northbound when a deer entered the roadway. Veh1 slowed to avoid

0

 

 

2

34

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the deer as it ran across the road. Veh2, speeding, was unable to brake in time and

 

 

 

C/M ZONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rear-ended Veh1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JUNCT'N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EVENT - 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EVENT - 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

0

38

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIX OBJ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

5

39

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLL

 

TY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNIT #

43

 

NAME

 

(First,

Middle,

 

 

Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

44

 

SEX

45

UNIT #

43

NAME

(First,

Middle,

Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

44

 

SEX

45

0

 

 

1

 

 

 

Brandy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Orr

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

2

0 2

 

 

Walter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Joseph

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

1

TYPE

 

 

46

 

ADDRESS (No.,

 

Street, City, State, Zip)

 

 

 

 

 

 

 

 

 

 

 

 

TEL

Work

 

 

 

Res

 

 

 

47

 

INJ

48

TYPE

46

ADDRESS

(No., Street, City, State,

Zip)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TEL

 

 

Work

 

 

 

Res

 

 

 

 

47

 

INJ

48

OF

 

 

 

4602 Oldham St

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6 4 1 6 1 9 2 0 6 5

 

0 2

OF

 

 

4676 Everett St

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 4 0 4 5 8 4 6 7 6

 

0

3

UNIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMS

49

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMS

49

DRIVER

 

Annapolis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MD

24744

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER

Annapolis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MD

84381

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

"PED"

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

"PED"

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82-1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOWED VEH (S)

 

 

 

 

84

 

82-1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOWED VEH (S)

 

 

 

 

84

4

 

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 8

 

 

Annapolis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MD 47344

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82-2

 

YEAR & MAKE OF VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

MODEL

 

 

 

 

 

 

 

 

 

 

1st IMPACT PT.

87

 

1

 

 

0

 

82-2

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82-3

 

EXP YR & REGISTR # STATE

 

 

 

 

 

AREAS DAMAGED

 

 

 

 

 

 

INSURER

 

 

 

 

 

 

 

 

 

 

 

82-3

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82-4

 

VEHICLE ID NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

 

 

 

82-4

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

95

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

96

 

 

 

94

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

95

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

96

0

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAFFIC

 

SEATING

 

CODE all injured & uninjured PASSENGERS below. Use "W" for witness in TRAF UNIT and SEAT columns.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SAFETY

EQUIP

 

 

INJUR

 

EJEC-

 

EMS

UNIT #

 

POSITION

 

WRITE NAME & ADDRESS of Injured Passengers and Witnesses.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Witness telephone #.

 

SEX

 

 

 

 

 

 

 

AGE

 

EQUIP

PROB.

 

 

SEVER

 

 

TION

 

UNIT

 

 

 

 

97

 

 

 

 

 

 

 

98

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

99

 

 

 

100

 

 

 

 

 

 

 

 

 

101

 

 

 

 

102

103

 

 

104

 

 

 

 

105

 

 

106

0

 

 

1

 

 

 

0

5

 

 

 

Eric

 

 

 

 

 

 

 

 

 

G

 

Crosby

 

 

 

 

 

 

3448 Lillibridge St

 

 

 

 

Annapolis

 

 

 

MD 60665

 

 

1 4 8 9 5 8 5 6 8 1

0 1

 

 

0

2

6

 

1 1

 

0 1

 

 

0 1

 

0 1

 

 

0

0

 

 

1

 

 

 

0

3

 

 

 

Gavin

 

 

 

 

 

K

 

Sakic

 

 

 

 

 

 

 

 

 

 

2678 Brookview Dr

 

Annapolis

 

 

 

MD 15424

 

 

2 7 9 8 0 4 1 2 9 6

0 1

 

 

0

3

5

 

1 3

 

0 1

 

 

0 3

 

0 1

 

A

0

 

 

2

 

 

 

0

4

 

 

 

Elaine

 

 

 

 

 

H

 

Geller

 

 

 

 

 

 

 

 

 

 

3636 Monterey Dr

 

 

 

 

Annapolis

 

 

 

MD 38364

 

 

6 4 0 8 1 9 5 2 1 6

0 2

 

 

0

2

8

 

1 3

 

1 3

 

 

0 3

 

0 1

 

A

0

 

 

2

 

 

 

0

5

 

 

 

Penny

 

 

 

 

 

D

 

Manning

 

 

 

 

 

 

2638 S 55th St

 

 

 

 

Annapolis

 

 

 

MD 50596

 

 

4 8 6 3 8 1 6 9 8 3

0 2

 

 

0

1

8

 

1 1

 

0 1

 

 

0 1

 

0 1

 

 

0

0

 

 

2

 

 

 

0

6

 

 

 

Harold

 

 

 

 

 

Y

 

Mason

 

 

 

 

 

 

4946 Valley Rd

 

 

 

 

Annapolis

 

 

 

MD 62828

 

 

3 3 3 8 4 2 2 1 4 0

0 1

 

 

0

6

7

 

1 3

 

0 1

 

 

0 2

 

0 1

 

 

0

0

 

 

2

 

 

 

0

3

 

 

 

Ross

 

 

 

 

 

 

 

 

 

U

 

Williams

 

 

 

 

 

 

2753 Brighton Ave

 

Annapolis

 

 

 

MD 52732

 

 

1 7 9 6 4 3 3 9 0 7

0 1

 

 

0

0

4

 

1 4

 

1 3

 

 

0 2

 

0 1

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E UNIT

 

INJURED TAKEN BY:

 

 

 

 

 

 

 

 

 

 

INJURED TAKEN TO:

 

 

 

 

 

 

 

 

 

 

 

 

EMS RUN REPORT #

 

E UNIT

 

INJURED TAKEN BY:

 

 

 

 

 

 

 

 

 

 

 

INJURED TAKEN TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

EMS RUN REPORT #

 

 

 

M

107

 

EmergyStat

 

 

 

 

 

108

 

Annapolis General

 

 

 

 

 

 

109

 

34-235

 

 

 

 

110

M

107

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

108

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

109

 

 

 

 

 

 

 

 

 

 

 

 

 

110

S A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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MSP FORM #1

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MSP - CENTRAL RECORDS DIVISION COPY

File Specifics

Fact Name Details
Purpose The Maryland Motor Vehicle Accident Report form documents details of motor vehicle accidents for legal and insurance purposes.
Governing Law This form is governed by Maryland Transportation Code, Section 20-104.
Filing Requirement Accidents resulting in injury, death, or property damage exceeding $1,500 must be reported using this form.
Form Accessibility The form is available online through the Maryland State Police website and can also be obtained at local police stations.
Report Number Each report is assigned a unique report number for tracking and reference purposes.
Accident Details Key details such as accident date, time, location, and involved vehicles must be accurately recorded on the form.
Involved Parties The form requires information about all drivers, passengers, and witnesses involved in the accident.
Diagram Requirement A diagram illustrating the accident scene and vehicle positions is a critical component of the report.
Submission Deadline The completed form must be submitted to the appropriate law enforcement agency within 15 days of the accident.
Data Privacy Personal information on the form is protected under Maryland privacy laws and should be handled accordingly.

How to Use Maryland Motor Vehicle Accident Report

Completing the Maryland Motor Vehicle Accident Report form is an essential step in documenting the details of a motor vehicle accident. The information collected will assist in investigations and claims processing. It is important to fill out the form accurately and completely to ensure all parties involved are properly represented.

  1. Obtain the Form: Access the Maryland Motor Vehicle Accident Report form from the Maryland Department of Transportation's website or request a physical copy from local law enforcement.
  2. Fill in the Report Number: Write the report number at the top of the form, if applicable.
  3. Enter the Accident Date and Time: Provide the date and time of the accident in the designated fields.
  4. Select the Report Type: Indicate whether the report is for a fatal accident, injury, property damage only, or other types of incidents.
  5. Provide Local Case Number: If there is a local case number assigned by law enforcement, include it in the appropriate section.
  6. Document the Investigating Officer: Write the name and identification number of the officer investigating the accident.
  7. Fill in Agency and Area: Enter the agency handling the report and the area of the accident.
  8. Describe the Accident Location: Include the road name, direction of travel, and any relevant traffic signals or ramp information.
  9. Detail the Accident Circumstances: Provide a brief description of what occurred during the accident, including any objects damaged and the nature of the damage.
  10. Identify Vehicles Involved: Fill in the details for each vehicle involved, including the driver's name, address, and vehicle information such as make, model, and year.
  11. List Injured Parties: Document the names, addresses, and injuries of any individuals involved in the accident, including passengers and pedestrians.
  12. Complete Additional Sections: Fill out any remaining sections, including weather conditions, road conditions, and diagrams of the accident scene if required.
  13. Review the Form: Double-check all information for accuracy and completeness before submitting the form.
  14. Submit the Form: Send the completed form to the appropriate agency as instructed, ensuring you keep a copy for your records.

Your Questions, Answered

  1. What is the Maryland Motor Vehicle Accident Report form?

    The Maryland Motor Vehicle Accident Report form is a document used to report details of a motor vehicle accident that occurs within the state of Maryland. It captures essential information about the accident, including the parties involved, the vehicles, and any injuries or damages.

  2. When do I need to complete this form?

    You need to complete this form if you are involved in a motor vehicle accident in Maryland that results in injury, property damage, or if the accident is classified as a hit-and-run. It's important to file the report as soon as possible after the incident.

  3. How can I obtain the form?

    The form can be obtained online from the Maryland Department of Transportation's Motor Vehicle Administration (MVA) website. You can also request a physical copy from your local law enforcement agency.

  4. What information do I need to fill out the form?

    You'll need to provide several details, including:

    • Your name, address, and contact information
    • The names and contact information of other parties involved
    • Details about the vehicles, such as make, model, and license plate numbers
    • A description of the accident and any injuries
  5. Who should submit the form?

    The driver involved in the accident is typically responsible for submitting the form. However, if the driver is unable to do so, another party involved in the accident can submit it on their behalf.

  6. What happens after I submit the form?

    Once submitted, the report will be reviewed by the appropriate authorities. It may be used for insurance purposes, legal proceedings, or to help law enforcement analyze accident trends.

  7. Is there a deadline for submitting the form?

  8. What if I don't have all the information needed?

    If you don't have all the information, fill out as much as you can. It's better to submit an incomplete form than not submit it at all. You can provide additional details later if needed.

  9. Can I get a copy of the report?

    Yes, you can request a copy of the report from the local law enforcement agency that handled the accident. There may be a small fee for obtaining a copy.

  10. What if the accident involved a hit-and-run?

    If the accident involved a hit-and-run, it’s crucial to report it to law enforcement immediately. Make sure to include all details you remember about the other vehicle in your report.

Common mistakes

  1. Incomplete Information: Failing to fill in all required fields can lead to delays in processing the report. Each section is crucial for a complete understanding of the incident.

  2. Incorrect Accident Description: Providing an unclear or inaccurate description of the accident may hinder investigations. It's essential to clearly outline what occurred, including details about the vehicles involved and the circumstances leading to the incident.

  3. Missing Witness Information: Not including contact details for witnesses can limit the ability to corroborate accounts of the accident. If there are witnesses, their information should be documented accurately.

  4. Omitting Vehicle Details: Failing to provide complete vehicle information, such as make, model, and registration numbers, can complicate insurance claims and investigations. Ensure that all vehicle details are accurate and comprehensive.

  5. Neglecting to Sign the Report: Forgetting to sign the report may render it invalid. A signature is often required to verify the information provided and confirm its accuracy.

Documents used along the form

When dealing with a motor vehicle accident in Maryland, several important forms and documents accompany the Maryland Motor Vehicle Accident Report. Each of these documents serves a unique purpose and is essential for thorough documentation and processing of the incident.

  • Insurance Claim Form: This form is submitted to the insurance company to initiate a claim for damages or injuries resulting from the accident. It includes details about the incident, the parties involved, and the extent of the damages.
  • Police Report: This document is prepared by law enforcement officers who respond to the accident scene. It contains vital information such as the circumstances of the accident, witness statements, and any citations issued. The police report is often crucial for legal and insurance purposes.
  • Medical Records: These records document any injuries sustained in the accident and the treatment received. They are essential for substantiating claims for medical expenses and can play a significant role in personal injury cases.
  • Witness Statements: Written accounts from individuals who witnessed the accident can provide valuable insights into what occurred. These statements can help clarify details and support the claims made by the involved parties.

Collecting and organizing these documents is vital for ensuring a smooth claims process and protecting your rights after an accident. Each form plays a critical role in building a comprehensive case.

Similar forms

The Maryland Motor Vehicle Accident Report form shares similarities with the police incident report. Both documents serve to document the details of an event involving law enforcement. They include crucial information such as the date, time, location, and involved parties. The police incident report often provides a narrative of the events leading to the incident, just as the Maryland form captures a detailed account of the accident circumstances. Both forms aim to create an official record that can be used for further investigation or legal proceedings.

Another document akin to the Maryland Motor Vehicle Accident Report is the insurance claim form. This form is essential for parties involved in an accident to file a claim with their insurance providers. Like the accident report, it requires detailed information about the incident, including the date, time, location, and descriptions of damages. Both documents are vital for determining liability and facilitating compensation, serving as foundational pieces of evidence in the claims process.

The medical report is also similar, particularly in cases where injuries occur. This report outlines the injuries sustained by individuals involved in the accident, detailing medical treatment and prognosis. The Maryland form and medical reports both emphasize the importance of accurate information regarding injuries, which can impact insurance claims and legal actions. They complement each other by providing a comprehensive view of the accident's consequences.

The vehicle registration document shares some characteristics with the Maryland Motor Vehicle Accident Report. Both documents contain information about the vehicles involved in the accident, including make, model, and registration details. This information is crucial for identifying the parties involved and assessing liability. While the accident report focuses on the incident itself, the registration document provides essential background on the vehicles, creating a fuller picture of the circumstances surrounding the accident.

In addition, the witness statement form is comparable to the Maryland report. Witness statements provide firsthand accounts of the accident, which can be critical in establishing facts. Both documents aim to capture the truth of the event, with the witness statement offering an external perspective that can corroborate the details recorded in the accident report. Together, they enhance the reliability of the information gathered about the incident.

Finally, the traffic citation is another document that aligns with the Maryland Motor Vehicle Accident Report. When a driver is issued a citation, it often relates to the circumstances of an accident. Both documents include information about the involved parties and the nature of the incident. The citation can indicate fault, while the accident report provides a broader context of the event. Together, they contribute to the legal framework surrounding traffic violations and accidents.

Dos and Don'ts

Filling out the Maryland Motor Vehicle Accident Report form is a crucial step after an accident. It is essential to approach this task with care to ensure accuracy and completeness. Here are eight important dos and don’ts to keep in mind:

  • Do provide accurate information about the accident, including the date, time, and location.
  • Do describe the accident clearly and concisely, noting all relevant details.
  • Do include information about all vehicles and individuals involved, ensuring you have correct names and addresses.
  • Do check the form for completeness before submitting it to avoid delays in processing.
  • Don’t leave out any important details, as this could lead to misunderstandings or legal issues later.
  • Don’t guess or assume information; if you are unsure, state that instead of providing inaccurate data.
  • Don’t forget to sign and date the report; an unsigned report may not be accepted.
  • Don’t submit the form without keeping a copy for your records, as this may be important for future reference.

By following these guidelines, you can help ensure that your report is processed smoothly and accurately. Take the time to fill out the form correctly, as it can significantly impact any claims or legal proceedings that may arise from the accident.

Misconceptions

Understanding the Maryland Motor Vehicle Accident Report form is essential for individuals involved in accidents. However, several misconceptions often arise regarding this document. Below are some common misunderstandings and clarifications to help navigate the process more effectively.

  • The report is only for serious accidents. Many people believe that the form is only necessary for fatal or severe injuries. In reality, it is important for all accidents, regardless of severity, to ensure accurate documentation and facilitate any necessary claims.
  • Only police officers can fill out the form. While law enforcement typically completes the report at the scene, individuals involved in the accident can also provide information. Their input can be valuable for accuracy and completeness.
  • The report is automatically filed with insurance companies. There is a misconception that once the report is completed, it is sent directly to insurance providers. However, individuals must often obtain a copy and submit it to their insurers themselves.
  • All information on the report is confidential. Some believe that the details in the report are private. In fact, these reports can be accessed by various parties, including insurance companies and legal representatives, depending on the situation.
  • Filing the report guarantees compensation. Many assume that completing the report ensures they will receive compensation for damages. While it is an important step in the claims process, compensation depends on the insurance policy terms and the specific circumstances of the accident.
  • There is no deadline for filing the report. Some individuals think they can submit the report at any time. However, there are specific timeframes within which the report must be filed, typically within 15 days of the accident, to avoid penalties.

By addressing these misconceptions, individuals can better understand the importance of the Maryland Motor Vehicle Accident Report form and its role in managing the aftermath of an accident.

Key takeaways

Filling out and using the Maryland Motor Vehicle Accident Report form is an important step following any vehicle accident. Here are some key takeaways to keep in mind:

  • Accurate Information is Essential: Ensure all details, including the date, time, and location of the accident, are filled out correctly. This helps in establishing a clear record of the incident.
  • Diagram the Accident: Use the diagram section to visually represent the accident scene. Label the roads, vehicles, and any objects involved. This can provide clarity during investigations.
  • Detail the Accident Description: Provide a brief but comprehensive description of what happened. Include information about the vehicles involved and any contributing factors like weather conditions.
  • List All Parties Involved: Include names, addresses, and contact information for all drivers, passengers, and witnesses. This information is crucial for follow-up and insurance claims.
  • Report Any Injuries: Clearly indicate if there were any injuries sustained during the accident. This is important for medical and legal purposes.
  • Submit the Form Promptly: After completing the form, submit it to the appropriate authorities as soon as possible. Timely submission can help expedite the claims process.