MV-198C (2/11)
New York State Department of Motor Vehicles
Use only for
accidents that happen
REQUEST FOR COPY OF ACCIDENT REPORT
in New York State.
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I am named in this accident report, or I am the
I am the authorized representative of a person who is, or
Please
who may be, a party to a civil action arising out of the
authorized representative of a person named in
choose one
conduct described in this accident report.
this report.
of the
I am a representative of New York State or of a political
I am, or may be, a party to a civil action arising
subdivision of New York State, and will use this accident report
following:
out of the conduct described in this accident report.
ONLY for statistics or research relating to highway safety.
Other reason:____________________________________
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:
If more than 3 motorists were involved, please
Accident Date: ____________________________________
attach an additional MV-198C.
Accident
Location (County): ____________________________________
Driver License ID No. or No. from Non-Driver ID Card
Plate No.
Fatal Accident:
YES
NAME
Date of Birth
Responding Police Agency:
NYC Precinct # ______________ Accident #___________________
Address
Apt. No.
NYS Police______________________________________________
City
State
Zip Code
Local __________________________________________________
Plate No.
Driver License ID No. or No. from Non-Driver ID Card
Plate No.
Driver License ID No. or No. from Non-Driver ID Card
NAME
Date of Birth
NAME
Date of Birth
Address
Apt. No.
Address
Apt. No.
City
State
Zip Code
City
State
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 . . . . . . . . . . ____________
$
Optional - Your reference number:
Total Amount Enclosed . . . . . . . . . . . . . . . . . . . . . . . ____________
$
_________________________________________
Please select payment method (Do Not Send Cash):
DMV USE ONLY
DMV account number
Date:______________________________________
Check/Money Order - Payable to Commissioner of Motor Vehicles
Exempt
Transaction #: ______________________________
Print name and address where the accident report(s) should be mailed:
Operator: __________________________________
Records Found
No Records Found
Search fee (non-refundable) . . . . . . . $10.00
No. of Reports _______ x $15 . . . . . ____________
$
Total . . . . . . . . . . . . . . . . . . . . . . . . . ____________
$
Amount Received . . . . . . . . . . . . . . . ____________
$
$
Refund. . . . . . . . . . . . . . . . . . . . . . . . ____________
MV-198C (2/11)
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