Vehicle Accident Report
Vehicle Accident Report Form. This is a Nevada form and can be use in Office Of Attorney General Statewide.
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