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DEPARTMENT OF RECORDS DATE OF …

CITY OF philadelphia DEPARTMENT OF RECORDSFACT SHEET ABOUT REQUESTS FOR AUTOMOBILE ACCIDENT REPORTSPLEASE RETAIN BOTTOM PORTION OF FORM FOR YOUR FILES. NOTE THE date YOU MAILED YOUR REQUESTS, DISTRICT CONTROL NUMBER, philadelphia CODE AND ANY OTHER INFORMATION THAT MAY BE PERTINENT TO CONTROL CODE NAME(S) OF DRIVERS/FILE NO. date MAILEDIt is essential that the information provided on this application is accurate. Information should include the following: date of accident, name of driver(s), loca-tion of accident, district control number and the philadelphia Code. The district control number and the philadelphia Code can be obtained by calling the police district where accident occurred. Insuffi cient or vague information may result in a negative Inquires are made and mail is sent to: DEPARTMENT of RecordsTraffi c Accident ReportsRoom 168, City HallPhiladelphia, PA 19107(215) 686-2266TO EXPEDITE SERVICE, PLEASE SEND A SELF-ADDRESSED, STAMPED CHECKS OR MONEY ORDERS PAYABLE TO "CITY OF philadelphia "FEE NOT REFUNDABLEPLEASE ALLOW 2 TO 3 WEEKS FROM date OF ACCIDENT BEFORE APPLYING FOR (Rev.)

city of philadelphiadepartment of records fact sheet about requests for automobile accident reports please retain bottom portion of form for your files.

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Transcription of DEPARTMENT OF RECORDS DATE OF …

1 CITY OF philadelphia DEPARTMENT OF RECORDSFACT SHEET ABOUT REQUESTS FOR AUTOMOBILE ACCIDENT REPORTSPLEASE RETAIN BOTTOM PORTION OF FORM FOR YOUR FILES. NOTE THE date YOU MAILED YOUR REQUESTS, DISTRICT CONTROL NUMBER, philadelphia CODE AND ANY OTHER INFORMATION THAT MAY BE PERTINENT TO CONTROL CODE NAME(S) OF DRIVERS/FILE NO. date MAILEDIt is essential that the information provided on this application is accurate. Information should include the following: date of accident, name of driver(s), loca-tion of accident, district control number and the philadelphia Code. The district control number and the philadelphia Code can be obtained by calling the police district where accident occurred. Insuffi cient or vague information may result in a negative Inquires are made and mail is sent to: DEPARTMENT of RecordsTraffi c Accident ReportsRoom 168, City HallPhiladelphia, PA 19107(215) 686-2266TO EXPEDITE SERVICE, PLEASE SEND A SELF-ADDRESSED, STAMPED CHECKS OR MONEY ORDERS PAYABLE TO "CITY OF philadelphia "FEE NOT REFUNDABLEPLEASE ALLOW 2 TO 3 WEEKS FROM date OF ACCIDENT BEFORE APPLYING FOR (Rev.)

2 12/11)THIS SPACE RESERVED FOR VALIDATIONFEE NOT REFUNDABLECOPIES OFFEEAPPLICANT'S FEETRAFFIC ACCIDENT REPORTPHOTOGRAPHS AVAILABLE FOR SUBJECT ACCIDENT$$$TOTAL $$ EACH$ PRINT$ EACHADD'L OF APPLICATION (PLEASE ALLOW 2 TO 3 WEEKS FROM date OF ACCIDENT)TELEPHONE NUMBER OF APPLICANTDATE OF ACCIDENTDATE ACCIDENT REPORTED TO POLICEYOUR CLAIM, POLICY OR FILE NUMBER (OPTIONAL)ACCIDENT INVESTIGATION DIVISION NUMBERCITY OF philadelphia DEPARTMENT OF RECORDSAPPLICATION FOR TRAFFIC ACCIDENTREPORT OR PHOTOGRAPHMAIL THIS PORTION WITH APPROPRIATE FEEIF YOU HAVE A DISABILITY AND REQUIRE AN ACCOMMODATION IN ORDER TO COMPLETE THIS FORM AND/OR TO PARTICIPATE IN A PROGRAM OR SERVICE, CONTACT THE ADA COORDINATOR AT OF APPLICANTADDRESS CITY STATE ZIP CODELOCATION OF ACCIDENTPERSON(S) INVOLVED (DRIVER OF VEHICLE)PERSON(S) INVOLVED (DRIVER OF VEHICLE, PEDESTRIAN, ETC.

3 DISTRICT CONTROL NUMBER philadelphia CODEPLEASE SEND A SELF-ADDRESSED, STAMPED TELEPHONESTO STOP A CRIMEOR SAVE A LIFEDIST. LOCATION TELEPHONE1st 24th & Wolf 686-30102nd Harbison & Levick 686-30203rd 11th & Wharton 686-30305th Ridge & Cinnaminson 686-30506th 11th & Winter 686-30607th Bustleton & Bowler 686-30708th Red Lion & Academy 686-30809th 401 N. 21st Street 686-309012th 65th & Woodland 686-312014th Haines W. of Gtn. 686-314015th Harbison & Levick 686-315016th 39th & Lancaster 686-316017th 20th & Federal 686-317018th 55th & Pine 686-318019th 61st & Thompson 686-319022nd 17th & Montgomery 686-322024th 3901 Whitaker Ave. 686-324025th 3901 Whitaker Ave. 686-325026th E. Girard & Montgomery 686-326035th N. Broad & Champlost 686-335039th 22nd & Hunting Park 686-3390 Airport 77th Int'l. Airport 937-6917-18 Acc. Inv. Div. 2531 W. Master St. 685-3181 Highway 686-310382-23 (Reverse) (Rev. 5/10)


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