Accident Report Request Form - City Of Minneapolis

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Minneapolis Police Department Accident Report Request Form
Case Control Number: MP _______________
Note: The accident report may not be located without the CCN
Date of Accident:
Location/Intersection of Accident:
Name(s) of person(s) involved in accident:
Name of Requester:
Address of Requester (include name of law firm or insurance firm, if applicable):
An Accident Report can only be provided to an Authorized Requestor. Following is a list
of five categories of Authorized Requesters. Please check your Category below:
Category 1: A person involved in the accident
(State Nature of Involvement (e.g., driver, passenger, pedestrian, vehicle owner etc.):
State Nature of involvement in accident:
Category 2: If a person involved in the accident is deceased, the representative of
the estate of the deceased, or the surviving spouse of the deceased, or the next of kin
of the deceased, or the trustee of the deceased
State Nature of Relationship to the Deceased:
Note: A death certificate must be provided. Legal representation document is also required.
Category 3: A person injured in person, property, or means of support or who
incurs other pecuniary loss because of the accident
State Nature of injury or nature of pecuniary loss:

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