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New Jersey Police Crash Investigation Report …

1041051111081091101121339697989910010110 2103106107113114115116117 Names & Addresses of Occupants - If Deceased, Date & Time of Death125124122123120121131 NJTR-1 (rev. 07/2005)Record Bureau CopySu M Tu W Th F Sa 1 Case Number5 Day of Week2 Police Dept ofCode3 Station/Precinct4 Date of Crashmm dd yy10 Crash Occurred On :12 Route No. Suffix13 Milepost Road NameAt Intersection withFeetMiles1415 NSEWof :1617 Cross Road NameNew Jersey Police Crash Investigation ReportPage ____ of ____ReportableNon-Reportable8 TotalKilled9 TotalInjured6 Time(use 2400 hrs)7 Municipality CodeInitial24 Policy Policy Ins Code55 Ins Code23 Veh NoLast Name26 Driver's First Name32 Driver s License No27 Number and Street28 CityInitialLast Name56 Driver's First Name State Zip58 City State Zip57 Number and Street62 Driver s License No31 State33 DOBmm dd yy61 State29 Sex35 Owner's First NameInitialLast NameSame AsDriver65 Owner's First NameInitialLast NameSame AsDriver36 Number and Street66 Number and Street37 City45 Expires State Zip67 City State Zip38 Make 40 Color43 State41 Year 42 Plate Color73 State71 Year 72 Plate

104 105 111 108 109 110 112 133 96 97 98 99 100 101 102 103 106 107 113 114 115 116 117 Names & Addresses of Occupants - If Deceased, Date & Time of Death 125 124 122

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Transcription of New Jersey Police Crash Investigation Report …

1 1041051111081091101121339697989910010110 2103106107113114115116117 Names & Addresses of Occupants - If Deceased, Date & Time of Death125124122123120121131 NJTR-1 (rev. 07/2005)Record Bureau CopySu M Tu W Th F Sa 1 Case Number5 Day of Week2 Police Dept ofCode3 Station/Precinct4 Date of Crashmm dd yy10 Crash Occurred On :12 Route No. Suffix13 Milepost Road NameAt Intersection withFeetMiles1415 NSEWof :1617 Cross Road NameNew Jersey Police Crash Investigation ReportPage ____ of ____ReportableNon-Reportable8 TotalKilled9 TotalInjured6 Time(use 2400 hrs)7 Municipality CodeInitial24 Policy Policy Ins Code55 Ins Code23 Veh NoLast Name26 Driver's First Name32 Driver s License No27 Number and Street28 CityInitialLast Name56 Driver's First Name State Zip58 City State Zip57 Number and Street62 Driver s License No31 State33 DOBmm dd yy61 State29 Sex35 Owner's First NameInitialLast NameSame AsDriver65 Owner's First NameInitialLast NameSame AsDriver36 Number and Street66 Number and Street37 City45 Expires State Zip67 City State Zip38 Make 40 Color43 State41 Year 42 Plate Color73 State71 Year 72 Plate VIN 74 VIN46 Vehicle Removed To76 Vehicle Removed To47 Authority Owner Driver Police77 Authority135 Crash Description136 Damage To Other Property137 Charge139 Charge138 Summons Badge Reviewed By

2 Badge Case StatusPendingComplete141 Officer's Signature11 Speed Limit30 Eyes75 Expires59 Sex60 Eyes63 DOBmm dd yy134 Crash Diagram (NOT TO SCALE)Indicate North < 10,000 lbs 10,001 - 26,000 lbs > 26,001 lbs51 Commercial Vehicle Weight 48 Alcohol/Drug Test49 Hazardous Material On BoardSpill_____Name or Placard Carrier No. 52 Carrier name81 Commercial Vehicle Weight 78 Alcohol/Drug Test79 Hazardous Material On BoardSpill_____Name or Placard Carrier No. 82 Carrier name39 Model68 Make 69 Model Owner Driver Police53 Veh NoChange ReportFatal34 Expires mm yy64 Expires mm yy < 10,000 lbs 10,001 - 26,000 lbs > 26,001 lbsMultiple ChargesMultiple Charges140 Summons *USDOTO ther *ImpoundDisabledDriven Left at Scene TowedImpoundDisabledDriven Left at Scene TowedPendingResults: __ %Given : No Yes Refused Type : Breath Blood Urine PendingResults: __ %Given : No Yes Refused Type.

3 Breath Blood Urine 92919089888786858483 ABCDE939594 ParkedPedHit & RunResp to EmergencyPedalcyclistParkedPedHit & RunResp to EmergencyPedalcyclistDir18 Speed Limit132130128d128c128b128a129d129c129b1 29a12612721 Latitude22 LongitudeNBSBEBWB19 RampTo:From:20 Route/NamePage _____ of _____New Jersey Police Crash Investigation ReportMotor Vehicle Crash DescriptionPolice Dept: _____ Code: _____Station: _____ Case No: _____Names & Addresses of Occupants - If Deceased, Date & Time of Death92919089888786858483 ABCDE939594 ALLINVOLVED(Refer to vehicle by number)VehOccPosIn/OnEjectPhysCondAgeTyp eInjLocInjSexRefMedEquipAvailHospCodeBag DeplEquipUsed135 Crash DescriptionNJTR-1A (rev. 07/2005)Officer's SignatureBadge NumberPage _____ of _____New Jersey Police Crash Investigation ReportMotor Vehicle Crash DiagramPolice Dept: _____ Code: _____Station: _____ Case No: _____134 Crash Diagram (NOT TO SCALE)NJTR-1B (rev.)

4 07/2005)Officer's SignatureBadge NumberIndicate North


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