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Kentucky State Police Accident Report Form

Kentucky State Police Accident Report Form

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Published by CJ WEB ADMIN
If you are in an accident, the is official form that you can fill out and send to your insurance company.
If you are in an accident, the is official form that you can fill out and send to your insurance company.

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Published by: CJ WEB ADMIN on Dec 06, 2013
Copyright:Attribution Non-commercial

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05/28/2014

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COMMONWEALTH OF KENTUCKY 
KSP-232 Revised 1/2002
CIVILIAN TRAFFIC COLLISION REPORT
MAIL TO:
 
KENTUCKY STATE POLICE, Records Branch, 1250 Louisville Road, Frankfort, KY 40601
Please Print Legibly or Type all Information. Use Black or Dark Blue Ink. Make Copies Before Mailing.Do Not Complete This Report if the Traffic Collision was Investigated by a Police Officer
Date of Collision Time
 AM / PM
 County This Collision Occurred In Limits of (City or Town) or Miles
N S E W
 of (City or Town)
ON
 Roadway Number
o r 
 Roadway Name Intersection Roadway Name/#
o r 
 Between Streets (Roadway Name/# ) 
YOUR INFORMATION
 (Vehicle 1
)
 
OTHER VEHICLE/PEDESTRIAN
 (Vehicle 2)
Driver 
 
Driver 
 First Middle Last First Middle Last Address Address Driver’s License (Number & State) Driver’s License (Number & State) Date of Birth (Month/Day/Year) Date of Birth (Month/Day/Year) Phone Phone
Owner of Vehicle Owner of Vehicle
 First Middle Last First Middle Last Address Address
Vehicle Vehicle
Make & Year Model Make & Year Model Registration Plate Number & State Registration Plate Number & State Insurance Company Insurance Company  Address Address Damage to Vehicle Damage to Vehicle Estimated Cost of Repairs Estimated Cost of Repairs
Damage to Property Other than Vehicle
 Owner’s Name Estimated Cost of Repairs Owner’s Address
DIAGRAM WHAT HAPPENED IN THIS COLLISION
 
DESCRIBE WHAT HAPPENED
(Number Vehicles, Your Vehicle is Vehicle 1)Indicate North by Arrow
N
Name of Person Completing Report Sign Here (Owner or Driver) Making Report Date of Report

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