REQUEST FOR COPY OF ACCIDENT REPORT Get accident reports instantly by purchasing them on the web. Visit http://dmv.ny.gov/AIS before you use this form. Use only for accidents that happen in New York State. I am the authorized representative of a person who is, orI am named in this accident report, or I am thePlease who may be, a party to a civil action arising out of theauthorized representative of a person named inchoose one conduct described in this accident report.this report. I am a representative of New York State or of a political of the I am, or may be, a party to a civil action arisingsubdivision of New York State, and will use this accident report following: out of the conduct described in this accident report. ONLY for statistics or research relating to highway safety. Other reason: Please Print Requester's Name and Address: Requester220s Signature X Date of Signature To knowingly make a false statement or conceal a material fact in this written statement is a criminal offense, punishable under Penal Law Section 210.45. Provide as much information as you can about the accident: Accident Date: / / If more than 3 motorists were involved, please attach an additional MV-198C. Accident Location (County): Fatal Accident: YES Responding Police Agency: NYC Precinct # Accident # NYS Police Local Plate No. Driver License ID No. or No. from Non-Driver ID Card NAME Date of Birth Address Apt. No. City State Zip Code Plate No. Driver License ID No. or No. from Non-Driver ID Card Plate No. Driver License ID No. or No. from Non-Driver ID Card NAME Date of Birth NAME Date of Birth Address Apt. No. Address Apt. No. City State Zip Code City State Zip Code Check boxes below for all reports you are requesting: Police Report Motorist Report (NAME)/ Motorist Report (NAME)/ Motorist Report (NAME) MV-198C (1/18) Mail completed form and payment to: NYSDMV, MV-198C Processing, 6 Empire State Plaza, Albany NY 12228.Non-refundable search fee. . . . . . . . . . . . . . . . . . . $10.00 No. of reports requested x $15. . . . . . . . . $ Optional - Your reference number: $Total Amount Enclosed. . . . . . . . . . . . . . . . . . . . . . . Please select payment method (Do Not Send Cash):DMV USE ONLY DMV account number Date:Check/Money Order - Payable to Commissioner of Motor Vehicles Exempt Transaction #: Print name and address where the accident report(s) should be mailed: Operator: Records FoundNo Records Found; Search fee (non-refundable) . . . . . . . $10.00; No. of Reports x $15 . . . .. $; Total . . . . . . . . . . . . . . . . . . . . . . . . . $; Amount Received. . . . . . . . . . . . . . . $; MV-198C (1/18) dmv.ny.gov Refund. . . . . . . . . . . . . . . . . . . . . . . . $ American LegalNet, Inc. www.FormsWorkFlow.com