Fill Out Your 12 209 Alaska Form
The Alaska Motor Vehicle Crash Form 12-209 serves as a crucial document for documenting details related to vehicle collisions in the state. When an accident occurs, this form captures essential information such as the location, time, and conditions of the crash, including the weather and lighting at the time. It allows responders to indicate the number of vehicles involved, the nature of damages, and any injuries sustained by drivers or passengers. The form further includes sections for identifying the drivers, their vehicles, insurance details, and the first sequence of events leading to the collision. Clear options guide users through selecting the circumstances surrounding the crash, while narrative spaces enable detailed descriptions for comprehensive reporting. Proper completion of this form is vital, as it aids law enforcement and insurance companies in processing claims and investigating incidents effectively. All individuals involved in the accident are required to provide their information, helping ensure accountability and accurate record-keeping.
12 209 Alaska Example
ALASKA MOTOR VEHICLE CRASH FORM
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C R A S H I N F O R M A T I O N |
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Total # Vehicles |
Crash Date |
Time of Crash |
am Crash Day |
01 MON |
03 WED |
05 FRI |
07 SUN |
Crash occurred in (City / Borough) |
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pm |
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02 TUE |
04 THU |
06 SAT |
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Name of Street or Highway |
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Miles |
North of: |
South of: |
Name of Cross Street, Highway, Bridge, etc. |
OFFICIAL USE ONLY |
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East of: |
West of: |
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Location Control |
Reference Point |
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Feet |
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At intersection with: |
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Weather |
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Lighting |
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Roadway / Junction |
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01 Blowing dirt, snow |
07 Sleet, hail (freezing rain) |
01 Dark - lighted roadway |
07 Not reported |
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01 Crossover |
07 Roundabout |
13 Other* |
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02 Clear |
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08 Severe crosswinds |
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02 Dark - not lighted |
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08 Unknown |
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02 Driveway |
08 T - intersection |
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03 Cloudy |
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09 Snow |
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03 Dark - unknown lighting |
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03 Not a junction |
09 Y - intersection |
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04 Fog/ smoke |
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10 Other* |
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04 Daylight |
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04 On ramp |
10 Four way intersection |
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05 Ice fog |
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11 Not reported |
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05 Twilight |
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05 Off ramp |
11 Five point or more |
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06 Rain |
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12 Unknown |
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06 Other* |
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06 Railway crossing |
12 Unknown |
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First Sequence of Events (what was the first thing you crashed into, or what was the first event that resulted in the crash. (CHECKONLY ONE FOR EITHER COLLISION OR |
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COLLISION |
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01 Aircraft |
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09 Ditch |
17 Median barrier |
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25 Train |
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33 Cargo loss / shift |
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40 Overturn |
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02 Animal |
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10 Embankment |
18 Moose |
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26 Tree / shrub |
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34 Crossed median / centerline |
41 Ran off road |
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03 Bicyclist |
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11 Fence |
19 Parked vehicle |
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27 Utility pole |
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35 Downhill runaway |
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42 Separation of units |
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04 Bridge / overpass |
12 Guard rail face |
20 Pedestrian |
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28 Vehicle in transit |
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36 Equipment failure |
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43 Other* |
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05 Bridge rail |
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13 Guard rail end |
21 Sideswipe |
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29 Vehicle - rear end |
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37 Explosion / fire |
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44 Unknown |
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06 Crash cushion |
14 Light support |
22 Sign |
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30 Vehicle - head on |
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38 Immersion |
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07 Culvert |
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15 Machinery |
23 Snowberm |
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31 Vehicle - angle |
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39 Jackknife |
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08 Curb / wall |
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16 Mail box |
24 Traffic signal pole |
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32 Other fixed object |
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Location of First Sequence of Events (where did the crash happen first?) |
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Road Surface |
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Did police |
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01 Bike lane |
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04 Outside of trafficway |
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07 Roadway |
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10 Unknown |
01 Dry |
04 Sand, mud, oil |
07 Wet |
Yes |
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investigate |
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02 Gore |
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05 Parking lot |
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08 Shared use paths |
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02 Ice |
05 Slush |
08 Other* |
No |
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this crash? |
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03 Median |
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06 Roadside |
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09 Shoulder |
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03 Water |
06 Snow |
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Y O U R D R I V E R I N F O R M A T I O N
Your Name (Vehicle Driver's Last Name, First Name, Middle Name)
Your Date of Birth
Your Contact Telephone
Your Mailing Address
Your Driver License Number
Your Driver License State
Your Driver License Country
Your City
Your State
Your Zip Code
Your Residence Country
Y O U R V E H I C L E I N F O R M A T I O N
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Your Vehicle Damage |
No. of Occupants |
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Your Vehicle Owner's Name (Last, First, Middle Initial) |
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Vehicle Owner's Telephone |
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01 None / minor |
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03 Disabling |
05 Unknown |
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Your Vehicle Owner's Mailing Address |
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02 Functional |
04 Totaled |
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02 |
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Your Vehicle Owner's City |
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Your Vehicle Owner's State |
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Vehicle Owner's Zip Code |
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Vehicle Year |
Vehicle Make |
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Vehicle Model |
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License Plate # |
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Vehicle License State |
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05 |
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Your Vehicle's Direction of Travel |
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Damage Estimate |
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01 North |
02 South |
03 East |
04 West |
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05 Unknown |
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Over $501 |
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Your Vehicle Driver's Injury Status (vehicle passengers are listed on page 2) |
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08 |
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01 Fatal |
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03 |
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05 None |
07 Unknown |
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CHECK ONLY ONE TO SHOW FIRST AREA OF IMPACT |
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02 Incapacitating |
04 Possible |
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06 Not reported |
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Roadway Circumstances (that may have contributed to the crash) |
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Your Vehicle Action |
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01 Debris |
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07 Road surface condition |
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13 Other* |
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01 Avoiding objects in road |
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08 Out of control |
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15 Straight ahead |
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02 Inoperative traffic device |
08 Ruts, holes, bumps |
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14 Unknown |
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02 Backing |
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09 Passing |
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16 Turning right |
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03 Missing traffic device |
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09 School zone |
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03 Changing lanes |
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10 Parked |
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17 Turning left |
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04 Obscured traffic device |
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10 Work zone |
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04 Entering traffic lane |
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11 Skidding |
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18 Other* |
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05 Obstruction in roadway |
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11 Worn, polished road surface |
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05 Leaving traffic lane |
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12 Slowing |
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19 Unknown |
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06 Shoulder |
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12 None |
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06 Making |
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13 Starting in traffic |
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07 Merging |
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14 Stopped |
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Traffic Control |
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Vehicle Configuration |
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01 Flashing signal |
05 School zone signs |
09 Officer / Flagman / Guard |
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01 Dog sled |
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05 Off highway vehicle |
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09 Other* |
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02 No traffic controls |
06 Stop sign |
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10 Yield sign |
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02 Light truck (4 tires) |
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06 Passenger car |
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10 Unknown |
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03 Road construction signs |
07 Traffic control signal |
11 Other* |
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03 Motorhome |
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07 Pedalcycle |
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04 RR crossing device |
08 Warning signs |
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12 Unknown |
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04 Motorcycle |
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08 Pedestrian |
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C R A S H D E S C R I P T I O N |
(Write a brief narrative describing the crash) |
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Fairbanks Police Department Rev. 07/05 |
Crash Form |
ALASKA MOTOR VEHICLE CRASH FORM
O T H E R D R I V E R ' S I N F O R M A T I O N
Other Driver's Name (Last Name, First Name, Middle Name)
Other Driver's Date of Birth
Other Driver's Contact Telephone
Other Driver's Mailing Address
Other Driver's License #
Other Driver's License State
Other Driver's License Country
Other Driver's Mailing Address City
Other Driver's State
Other Driver's Zip Code
Other Driver's Residence Country
O T H E R D R I V E R V E H I C L E I N F O R M A T I O N
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Other Vehicle Damage |
Other Vehicle No. of Occupants |
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Other Vehicle Owner's Name (Last, First, Middle Initial) |
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Other Vehicle Owner's Telephone |
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01 None / minor |
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03 Disabling |
05 Unknown |
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Other Vehicle Owner's Mailing Address |
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02 Functional |
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04 Totaled |
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02 |
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Other Vehicle Owner's City |
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Other Vehicle Owner's State |
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Other Vehicle Owner's Zip |
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Vehicle Year |
Vehicle Make |
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Vehicle Model |
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License Plate # |
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Vehicle License State |
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Other Vehicle's Direction of Travel |
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Damage Estimate |
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01 North |
02 South |
03 East |
04 West |
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05 Unknown |
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Over $501 |
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Other Vehicle Driver's Injury Status (vehicle passengers are listed below) |
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08 |
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06 |
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01 Fatal |
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05 None |
07 Unknown |
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CHECK ONLY ONE TO SHOW FIRST AREA OF IMPACT |
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02 Incapacitating |
04 Possible |
06 Not reported |
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Other Driver's Roadway Circumstances (that may have contributed to the crash) |
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Other Driver's Vehicle Action |
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01 Debris |
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07 Road surface condition |
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13 Other* |
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01 Avoiding objects in road |
08 Out of control |
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15 Straight ahead |
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02 Inoperative traffic device |
08 Ruts, holes, bumps |
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14 Unknown |
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02 Backing |
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09 Passing |
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16 Turning right |
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03 Missing traffic device |
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09 School zone |
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03 Changing lanes |
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10 Parked |
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17 Turning left |
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04 Obscured traffic device |
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10 Work zone |
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04 Entering traffic lane |
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11 Skidding |
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18 Other* |
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05 Obstruction in roadway |
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11 Worn, polished road surface |
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05 Leaving traffic lane |
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12 Slowing |
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19 Unknown |
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06 Shoulder |
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12 None |
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06 Making |
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13 Starting in traffic |
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07 Merging |
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14 Stopped |
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Other Driver's Traffic Control (traffic control for the other driver may have been different from yours) |
Other Driver's Vehicle Configuration |
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01 Flashing signal |
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05 School zone signs |
09 Officer / Flagman / Guard |
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01 Dog sled |
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05 Off highway vehicle |
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09 Other* |
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02 No traffic controls |
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06 Stop sign |
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10 Yield sign |
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02 Light truck (4 tires) |
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06 Passenger car |
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10 Unknown |
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03 Road construction signs |
07 Traffic control signal |
11 Other* |
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03 Motorhome |
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07 Pedalcycle |
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04 RR crossing device |
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08 Warning signs |
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12 Unknown |
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04 Motorcycle |
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08 Pedestrian |
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I N J U R Y S E C T I O N |
(Fill in the name of injured person, injury status, telephone number, and which vehicle they occupied when the crash occurred) |
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Name
Injury Status |
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Telephone |
Vehicle License |
02 Incapacitating |
03 |
04 Possible |
05 None |
07 Unknown |
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02 Incapacitating |
03 |
04 Possible |
05 None |
07 Unknown |
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02 Incapacitating |
03 |
04 Possible |
05 None |
07 Unknown |
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02 Incapacitating |
03 |
04 Possible |
05 None |
07 Unknown |
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YOUR INSURANCE INFORMATION |
C E R T I F I C A T E O F |
I N S U R A N C E |
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Failure to complete the Certificate of Insurance could |
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result in the suspension of your driver's license) |
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CRASH |
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Crash Date |
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Crash Location |
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INFORMATION |
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Your Name (Driver's Last Name, First Name, Middle Initial) |
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Your Date of Birth |
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Your Driver's License Number |
Your Driver's License State |
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DRIVER |
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INFORMATION |
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Your Mailing Address |
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Your City |
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Your State |
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Your Zip Code |
Your Contact Telephone |
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VEHICLE |
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Vehicle Owner's Name (Last Name, First Name, Middle Initial) |
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Owner's Date of Birth |
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Owner's License Number |
Owner' License State |
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OWNER |
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Vehicle Owner's Mailing Address |
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Owner's City |
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Owner's State |
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Owner's Zip Code |
Owner's Contact Telephone |
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INFORMATION |
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VEHICLE |
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Vehicle year |
Vehicle make |
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Vehicle model |
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License plate # |
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Vehicle License State |
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Vehicle Identification Number (VIN) |
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INFORMATION |
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Did you have a current automobile liability policy in effect covering this accident? |
YES |
NO |
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Insurance Company or Insurance Carrier Name |
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Insurance Policy Number |
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INSURANCE |
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INFORMATION |
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Address and Telephone Number of Insurance Agent |
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Insurance Policy |
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SIGNATURE |
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YOUR SIGNATURE |
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INSURANCE VERIFICATION: If the motor vehicle liability insurance policy listed above was not in effect for the motor vehicle listed at the time of the crash indicated above, the insurance company is to complete the following and return this form to the Division of Motor Vehicles at the address listed on the bottom right corner on page 2 of this form. If indicated coverage was in effect at the time of the crash, no action is required.
REASON FOR DENIAL:
Policy expired before crash |
Driver is not covered on policy |
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Policy effective after crash |
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Policy number given is incorrect |
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Authorized Representative Signature / Date |
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MAIL THIS FORM TO:
DMV MAIN OFFICE
P.O. BOX 110221
JUNEAU, AK
(907)
Crash Form
Form Characteristics
| Fact Name | Details |
|---|---|
| Form Purpose | The 12-209 form is designed to report motor vehicle crashes in Alaska. |
| Governing Laws | The form complies with Alaska Statutes Section 28.35.080 regarding accident reporting. |
| Required Information | Drivers must provide details about the crash, including date, time, location, and involved vehicles. |
| Weather and Road Conditions | The form asks for information about weather and roadway conditions at the time of the crash. |
| First Impact Sequence | Users must identify what the vehicle first collided with, whether it was a person, animal, or object. |
| Filing Location | The completed form must be sent to the Alaska Department of Motor Vehicles, specifically to their Juneau office. |
Guidelines on Utilizing 12 209 Alaska
Completing the Alaska Motor Vehicle Crash Form 12-209 is a crucial step for those involved in a crash. Filling it out accurately helps ensure that all necessary information is documented for future reference and legal compliance. To guide you through the process, here are the steps to follow when filling out the form.
- Fill in the crash information section:
- Enter the total number of vehicles involved.
- Indicate the crash date and time.
- Provide city or borough information where the crash occurred.
- Name the street or highway along with relevant intersections.
- Describe the weather and lighting conditions at the time of the crash.
- Specify the first sequence of events:
- Select only one option that represents the first thing that was crashed into or the initial event that caused the crash.
- Identify the location of the first impact and the road surface conditions.
- State whether the police investigated the crash.
- Provide your driver information:
- Enter your name, date of birth, contact telephone number, and mailing address.
- Provide your driver license number, state, country, and residency information.
- Input your vehicle information:
- Detail the damage to your vehicle, including the number of occupants.
- List the vehicle owner's name, telephone number, and mailing address.
- Specify the vehicle year, make, model, license plate, and direction of travel.
- Mention any injuries sustained by vehicle occupants.
- Document the information for the other driver:
- Fill out the other driver's name, contact information, and vehicle details.
- Provide their vehicle's damage assessment and direction of travel.
- Include any observed injuries and roadway conditions pertaining to the other driver.
- Complete the injury section:
- List names, injury status, and telephone numbers for each injured person.
- Record which vehicle each individual occupied during the crash.
- Fill in your insurance information:
- Indicate if you had an active automobile policy at the time of the crash.
- Provide insurance company details and policy numbers.
- Sign and date the form in the designated section.
- Mail the completed form to the DMV office in Juneau, AK, using the address provided in the instructions.
After following these steps, double-check the form for accuracy and completeness before mailing. Submitting the form promptly can help streamline the process and may assist in resolving any associated legal or insurance matters more efficiently.
What You Should Know About This Form
What is the purpose of the Alaska Motor Vehicle Crash Form 12-209?
The Alaska Motor Vehicle Crash Form 12-209 is used to report information about motor vehicle accidents that occur in the state of Alaska. This form collects details about the crash, such as the date, time, location, vehicles involved, and any injuries sustained. Accurate completion of this form is essential for documentation and can assist in insurance claims and legal matters related to the crash.
Who needs to complete the form?
Both drivers involved in the crash are typically required to complete the form. Each driver provides information about their vehicle, their actions during the incident, and any injuries sustained. If there are multiple vehicles, each driver should file a separate form, ensuring all details are captured correctly.
What information is required on the form?
The form requires several pieces of information, including the names of the drivers, their contact details, license numbers, and vehicle information such as make, model, and damage assessment. The form also asks for specifics about the crash, like the first event leading to the accident, road conditions, weather factors, and any traffic control devices present at the scene.
What if there are injuries involved?
If there are injuries, it is critical to indicate the injury status for each person involved in the crash. There are options for different levels of injury, ranging from fatal to non-incapacitating. Accurate reporting can help ensure appropriate medical attention and assist with any subsequent claims made through insurance or legal channels.
How does the form affect insurance claims?
Completing the 12-209 form accurately is crucial for processing insurance claims. Insurers often require a detailed accident report to determine the circumstances of the crash and to assess liability. Failure to provide correct information may lead to delays or disputes regarding claims, coverage, or fault determinations.
What should I do if I cannot complete the form at the scene?
If you are unable to complete the form at the scene of the accident, it is advisable to do so as soon as possible afterward. Gather all necessary information regarding the accident and all parties involved. If you require assistance, someone familiar with the report may help guide you through the process. It’s important to submit the form to the appropriate authority within the required timeframe.
Is there a deadline for submitting the form?
There is no explicitly stated deadline for submitting the Alaska Motor Vehicle Crash Form 12-209 on the form itself. However, it is generally advisable to complete and submit the form as soon as possible. Timely reporting aids in the resolution of insurance claims and legal obligations that may arise from the crash.
Where do I submit the completed form?
Once the form is completed, it should be mailed to the DMV Main Office at P.O. Box 110221, Juneau, AK 99811-0221. Ensure you keep a copy of the completed form for your records and follow up if you do not receive confirmation of its receipt.
Common mistakes
Completing the Alaska Motor Vehicle Crash Form (12-209) accurately is crucial for ensuring your report is processed without delay. Many individuals, however, fall into common traps that can lead to errors or omissions. Here are seven frequent mistakes to avoid when filling out this form.
One of the primary mistakes is failing to select the correct crash date or time. This information is critical as it helps to document the specific circumstances surrounding the incident. Be careful to note whether the crash occurred in the AM or PM, and choose the appropriate day. Incorrect entries could create confusion and affect the investigation.
Another common error involves inaccurately reporting the location of the crash. It is essential to provide a precise description, including streets, cross streets, and distances from known reference points. Ambiguities in location can make it challenging for authorities to follow up and could hinder any further legal processes.
Many people also neglect to fill out the driver and vehicle information completely. Ensuring that all sections pertaining to your vehicle and personal details are completed accurately, such as your driver's license number and contact information, is vital. Missing or incorrect details can lead to significant delays or issues when processing your claim.
Another mistake is skipping over the 'First Sequence of Events' section. This part allows you to clarify what exactly happened first during the crash. Choosing the correct event helps officers and insurers understand the situation better and can influence the conclusion of fault.
Moreover, individuals often forget to include their insurance information. This part is not only important for reporting the crash but also essential for ensuring that proper liability coverage is considered. Any omission may lead to complications such as fines or penalties regarding your driver's license.
People sometimes also overlook the importance of confirming the accuracy of vehicle damage descriptions. Given the varying levels of severity associated with vehicle damage, it is important to select the correct category. Misclassification could lead to disputes regarding claims or liability.
Finally, disregarding the need for signatures can lead to significant problems. Your signature is necessary to validate that the form is accurate and reflects your account of events. Omitting this can render your report incomplete, potentially delaying response times and resolution of the incident.
By being mindful of these common mistakes, you can ensure that your completion of the Alaska Motor Vehicle Crash Form is thorough and accurate, facilitating a smoother resolution of any associated claims.
Documents used along the form
The Alaska Motor Vehicle Crash Form 12-209 is a critical document in the event of a vehicle collision. To facilitate the proper handling of a crash incident, several other forms and documents may accompany the 12-209. Each of these documents plays a specific role in ensuring that all necessary information is properly recorded and communicated to relevant parties, such as law enforcement, insurance providers, and crash victims.
- Alaska DMV Crash Report: This document serves as an official statement from the Alaska Department of Motor Vehicles, compiling essential details about the accident, parties involved, and witness statements. It may be required for insurance claims and legal purposes.
- Insurance Claim Form: When seeking compensation for damages or injuries, an insurance claim form is necessary. This document outlines the specifics of the claim, including details about the crash and the extent of damages or injuries experienced.
- Witness Statements: If there are individuals who observed the accident, their statements can provide valuable corroboration. Collecting contact information and testimonials from these witnesses may strengthen a case or help clarify conflicting accounts.
- Driver's Insurance Information: This document confirms the insurance details of each driver involved. It includes policy numbers and the contact information of insurance providers, which can expedite the claims process.
- Medical Records: If injuries occurred due to the crash, medical records become vital. They document the nature and extent of injuries, providing essential evidence for any insurance claims or potential litigation.
- Vehicle Damage Estimate: A detailed evaluation of the damages to each vehicle involved helps assess repair costs. This estimate is often necessary to support claims made through insurance.
- Police Report: If law enforcement responded to the crash, their report would detail the circumstances surrounding the incident. This document can be crucial in determining liability.
- Accident Reconstruction Report: In complex cases, especially those involving serious injuries or fatalities, an accident reconstruction report may be prepared. This document analyzes the crash's physics and dynamics, offering insights into how the accident occurred.
- Statement of Loss or Damage: This form lists all losses incurred as a result of the crash. It outlines not just vehicle damage, but also personal property loss, medical expenses, and lost wages if applicable.
By gathering these documents, individuals involved in a vehicle crash in Alaska can ensure that they have a comprehensive record of the incident. This preparation can facilitate communication with legal and insurance professionals, ultimately aiding in the resolution of claims and restoration of normalcy following the accident.
Similar forms
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Form SR-1 (Accident Report): Similar to the 12-209 form, the SR-1 is designed to capture details about motor vehicle accidents in Alaska. Both forms collect information such as crash location, vehicles involved, and driver information. However, the SR-1 is used more broadly across states, while the 12-209 specifically addresses the nuances of Alaskan regulations.
-
California Highway Patrol 555 Form: This form is used in California for reporting motor vehicle accidents. Like the 12-209, it gathers information about vehicle damage, weather conditions, and personal information of drivers involved. The key difference lies in the geographic and regulatory context in which each form operates.
-
Michigan Traffic Crash Report (UD-10): Michigan's UD-10 report serves a similar purpose, documenting the specifics of traffic crashes. Similarities include sections detailing driver and vehicle information as well as crash circumstances. The reporting format may vary, reflecting the specific requirements of each state's law enforcement.
-
Texas CR-3 Crash Report: Texas utilizes the CR-3 form to record vehicle accidents. This document is comparable to the 12-209 in that it involves capturing information on the crash’s location, contributing factors, and details regarding the involved parties. Texas law and protocols will dictate how the data is processed and utilized.
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New York State MV-104 Accident Report: In New York, the MV-104 is required for reporting accidents. Similar to the 12-209 form, it collects detailed data on the incident, including the parties involved, vehicles impacted, and crash circumstances. Each state imposes specific time frames and penalties related to these forms, affecting how they are submitted and processed.
Dos and Don'ts
When filling out the Alaska Motor Vehicle Crash Form 12-209, it's essential to keep a clear focus on accuracy and completeness. Here are eight important do's and don'ts to guide you through the process:
- Do read the instructions carefully before starting to fill out the form.
- Do provide accurate information regarding the date and location of the crash.
- Do double-check your contact information and driver’s license details for correctness.
- Do describe the sequence of events leading to the crash clearly in the designated section.
- Don't leave any sections blank; incomplete forms can lead to delays.
- Don't use abbreviations or shorthand; write out full words for clarity.
- Don't add any unnecessary information; stick to what is relevant to the crash.
- Don't forget to sign and date the form before submitting it.
Following these guidelines can help ensure a smoother process and reduce the likelihood of errors that can prolong your case review.
Misconceptions
- Misconception 1: The 12-209 form only applies to major accidents.
- Misconception 2: Only the police are responsible for completing the form.
- Misconception 3: The crash report is not needed if the injuries are minor.
- Misconception 4: The location of the crash is irrelevant in the report.
- Misconception 5: You can submit the form anytime after the crash.
- Misconception 6: Only one driver needs to complete the form.
This form is required for all types of crashes, even minor ones. Regardless of the severity, if there is property damage or injury, this form must be filled out.
While law enforcement may assist, it is the duty of the driver or the involved party to ensure the form is accurately completed. This information is crucial for insurance and legal purposes.
Detailing the location helps authorities assess accident patterns and improve safety measures. Accurately reporting the crash site is important for statistical analysis and potential follow-up actions.
There are specific timeframes for submitting the 12-209 form. Delays may lead to complications with insurance claims or legal proceedings, so timely submission is crucial.
In multi-vehicle crashes, every driver involved should complete the 12-209 form. Each perspective is important for a comprehensive understanding of the accident.
Key takeaways
1. Accurate Information is Crucial: Ensure that all details, including names, addresses, and vehicle information, are filled out accurately. Mistakes can lead to delays or complications during processing.
2. Complete All Sections: Every section of the form must be completed to provide a comprehensive overview of the crash. Missing information can hinder investigation efforts.
3. Narrative Description is Important: Include a brief narrative description of the crash. This helps clarify circumstances and may be essential in resolving disputes or insurance claims.
4. Submit Timely: Submit the completed form promptly to avoid any penalties or issues related to your driver's license. Follow the mailing instructions carefully to ensure it reaches the right department.
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