City of Meridian - Vehicle Collision Report

IMPORTANT INFORMATION: The purpose of this form is for citizens to document and make a voluntary report of a vehicle collision with the Meridian Police Department. The police did not investigate this crash and no police action will be taken based on the information provided.

Was information exchanged between drivers? Required

Yes

Was a police officer called to the scene? Required

Yes

Collision Information

Collision Date/Time:

Date: Time:

Collision Location Type:

City:

State/Zip:

Collision Location:

Collision Description:

Driver/Vehicle #1 Information (Your Vehicle, Unit #1)

Name Of Driver:

Driver Address:

City:

State/Zip:

Driver's License #:

Date Of Birth:

Home Phone:

Registration Info Same As Driver

Registered Owner:

Registered Owner Address:

City:

State/Zip:

Vehicle Lic. Plate#:

Vehicle Information:

Insurance Information:

Damage To Vehicle:

(+) Add Driver/Vehicle #2 Information

(+) Add Driver/Vehicle #3 Information

(+) Add Driver/Vehicle #4 Information

(+) Add Driver/Vehicle #5 Information

(+) Add Driver/Vehicle #6 Information

Other Person Involved #1 (Optional)

Other Person Vehicle/Unit:

Other Person Type:

Other Person Name

Other Person Phone:

Other Person Address:

City:

State/Zip:

Property Damage:

Damage Cost (Estimated):

(+) Add Other Person Involved #2 (Optional)

(+) Add Other Person Involved #3 (Optional)

(+) Add Other Person Involved #4 (Optional)

(+) Add Other Person Involved #5 (Optional)

(+) Add Other Person Involved #6 (Optional)

Reporting Person's Information

Reporting Person Info Same As Driver 1

Your Name:

Your Phone Number:

Your E-Mail Address:

Your Address:

City:

State/Zip:

Notice: Filing a false police report is a crime. By submitting the driver's statement, you are stating that this is true and correct to the best of your knowledge.

Electronic Signature: