Car/Deer Accident Form

Public Safety Sheriff’s Office Car/Deer Accident Form

Company

This field is for validation purposes and should be left unchanged.

Contact Information

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Driver's License Number(Required)

Email(Required)

Date of Birth(Required)

Gender(Required)

Female

Male

Vehicle Information

Vehicle Year(Required)

Vehicle Color(Required)

Vehicle Type(Required)

Vehicle Make(Required)

(Ford, Chevrolet, Chrysler, etc.)

Vehicle Model(Required)

(Impala, Taurus, etc.)

VIN Number(Required)

Vehicle Plate Number(Required)

Plate Expiration Date(Required)

Insurance Information

Name of Insurance Company(Required)

Insurance Policy Number(Required)

Insurance Company Address(Required)

Accident Information

Date of Accident(Required)

Time of Accident(Required)

Weather at Time of Crash(Required)

Light Condition(Required)

Road/Street Accident Occurred(Required)

Nearest Crossroad(Required)

Direction From Nearest Crossroad(Required)

Approximate Distance from Nearest Crossroad(Required)

Direction of Travel(Required)

Road Conditions(Required)

Location of First Damage(Required)

Location of Most Damage(Required)

Extent of Damage(Required)

Minor

Moderate

Extensive

Number of Occupants(Required)

When you are satisfied the form is complete, submit by email using the submit button below. Once we have received your information, you will be contacted with an accident report number. Please select how you would like to receive that information.

Desired Method of Contact(Required)

Phone/Message

Text Message

Full Name(Required)

Date(Required)

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