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Vehicle Accident Report Form. This is a Nevada form and can be use in Office Of Attorney General Statewide.
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Tags: Vehicle Accident Report, TC-3, Nevada Statewide, Office Of Attorney General
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
For State Use Only:
State Claim No. __________
:
Calendar No.
Budget Acct. No.
VEHICLE ACCIDENT REPORT
_________
:
JUDICIAL SUBPOENA
Plaintiff(s)
Coverage _______________
INSTRUCTIONS: (If you need more space, attach a separate sheet of paper)
Adjuster ________________
-against-
State of Nevada
Complete as much information as possible at the scene. :
REPORT all accidents involving third parties, whether or not there is damage or injury.
:
Cooperate with investigating officer(s) and the State’s adjuster(s).
Notify Attorney General’s Office ASAP if there is an injury. Tel.: (775) 684-1263; Fax: (775)
:
684-1275
Sent original to AG’s Office
Claims Manager, Office of the Attorney General,
Defendant(s)
:
. . . . . . . . WITHIN .48 .HOURS. . . . . . . 100 . . . Carson .Street, Carson City, NV 89701
........ .. .......
. . . . N. . . . . . . . . . . . .
Sent copy to Risk Management
WITHIN 48 HOURS
Risk Management, 201 S. Roop Street, Suite 201,
Carson City, NV 89701
THE PEOPLE OF THE STATE OF NEW YORK
A.M.
Date TO Accident ______________ Time ________ P.M.
of
Location of
Accident _______________________
OUR INFORMATION:
Driver’s Name _______________________________ Agency ______________________________
GREETINGS:
Office Address ___________________________________________ Bus. phone ______________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Driver’s Lic. No. ___________________________the
the Honorable
at State__________ Expiration Date ____________
Court
located at
County of
Contact Person __________________________ Title ________________ Phone ______________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or a MOTOR POOL vehicle? evidence as aNo
adjourned date, to testify and give Yes
witness in this action on the part of the
Is this
Vehicle ID No.(VIN) _____________________
Plate No. ____________ Year _______ Make _________________ Model ____________________
Location of Vehicle
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
________________________________________________________________________________ a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as
result of your failure to comply.
Describe damage to State vehicle:
Windshield damage only; no other party involved
________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
THEIR INFORMATION:County,
Self-insuranceof
card provided to driver/owner?
Yes
No
Court in
day
, 20
OWNER’S NAME _____________________________________ Daytime Phone _______________
Address _______________________________________ City/State/Zip above and type name below)
(Attorney must sign ______________________
Insurance Company ____________________ Policy No. ______________ City/State ____________
Insurance Agent ______________________________________ Phone No. ___________________
Attorney(s) for
Plate No. _____________ State ______ Year _____ Make _________ Model __________________
DRIVER’S NAME ___________________________________ Daytime Phone _________________
Office and P.O. Address
Address ________________________________________City/State/Zip _____________________
Driver’s Lic. No. ___________________________ State ________ Expiration Date _____________
Telephone No.:
Describe damage to other vehicle and any injuries reported Facsimile No.:
__________________________________
E-Mail Address:
________________________________________________________________________________
TC-3 (revision of RSK-001, 4/04)
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
,
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
Office of the Attorney General
:
EXPLAIN WHAT HAPPENED:
Calendar No.
________________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
________________________________________________________________________________
-against-
:
________________________________________________________________________________
:
________________________________________________________________________________
________________________________________________________________________________
:
________________________________________________________________________________
Defendant(s)
:
......................................................
Accident Reported to (NHP, Metro, Reno P.D., etc.) ______________________ Report # _________
Citations Issued?
No
Yes
If “Yes,” explain _______________________________________
THE PEOPLE OF THE STATE OF NEW YORK
Complete the following diagram showing direction and positions of automobiles involved.
Clearly designate point of contact.
Indicate by arrow
TO
the direction of
NORTH
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
path before accident - - - - - - path after accident ++++++ Railroad
Stop Sign
Stop Light
WITNESSES:
Witness card given/statement taken
Name
Address
Pedestrian
Phone
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
PERSONS INJURED: (If injured person is a State Employee, complete a Worker’s Compensation Claim Form.)
Name
Address
Phone
(Attorney must sign above and type name below)
Attorney(s) for
Agency Information:
Damage estimates attached
Estimates will follow
Office and P.O. Address
State Driver’s Signature _______________________________________ Date ________________
Telephone No.:
Reviewed by Safety Coordinator ________________________________ Date ________________
Facsimile No.:
E-Mail Address:
Reviewed by Department Head _________________________________ Date ________________
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
