%PDF-1.2 %туЯг 12 0 obj << /Length 13 0 R >> stream q 163.92 754.8 310.56 19.2 re h W n BT 163.92 759.12 TD 0 0 0 rg /F0 19.92 Tf 0.7608 Tc 2.5392 Tw (Commonwealth of Massachusetts) Tj ET Q BT 139.92 734.4 TD 0 0 0 rg /F0 19.92 Tf 0.7275 Tc 1.9725 Tw (Motor ) Tj 0.5785 Tc 2.5215 Tw (Vehicle Crash Operator Report) Tj 57.36 -204.72 TD /F0 18 Tf -0.08 Tc -0.58 Tw (How ) Tj -0.3683 Tc 0.1083 Tw (To Complete This Form) Tj -167.28 -15.12 TD /F1 8.88 Tf -0.228 Tc 1.148 Tw (Please carefully complete all sections of this form that apply to your crash,) Tj 0 Tc -0.3 Tw ( ) Tj 265.2 0 TD /F0 8.88 Tf -0.1492 Tc 0.9292 Tw (circling the answer) Tj 0 Tc -0.3 Tw ( ) Tj 74.16 0 TD /F1 8.88 Tf -0.2152 Tc 1.1686 Tw (where appropriate. Illegible reports will be returned to you.) Tj -294.48 -21.84 TD /F0 11.04 Tf 0.0379 Tc 1.3621 Tw (Section A: Crash Location) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18.48 -3.12 TD /F1 10.08 Tf 0.0373 Tc 0.6827 Tw (Provide the city/town where the crash occurred,) Tj -0.48 -12 TD 0.0719 Tc -0.1679 Tw (the date and time of the crash, and the number of) Tj 0 -12 TD 0.0122 Tc -0.1322 Tw (vehicles involved.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18.48 -3.12 TD /F1 10.08 Tf -0.0374 Tc -0.4026 Tw (Complete section A1 ) Tj 84.96 0 TD -0.4783 Tc 0 Tw (or) Tj ET 178.32 442.8 8.16 0.48 re f BT 186.48 444.48 TD 0.0141 Tc -1.0941 Tw ( A2.) Tj -111.6 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18.48 -3.12 TD /F1 10.08 Tf 0.0233 Tc -0.3147 Tw (Use official names of all locations, streets and) Tj -0.48 -12 TD -0.1553 Tc 0 Tw (landmarks.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc (n) Tj 18.48 -3.12 TD /F1 10.08 Tf -0.0232 Tc -0.3368 Tw (Use street name ) Tj 65.28 0 TD 0.1882 Tc 0 Tw (and) Tj ET 158.64 406.8 14.88 0.48 re f BT 173.52 408.48 TD -0.0012 Tc -0.4788 Tw ( route #, if applicable) Tj 83.76 0 TD 0.12 Tc 0 Tw (.) Tj -182.4 -8.88 TD /F2 5.28 Tf -0.1042 Tc (n) Tj 18.48 -3.12 TD /F1 10.08 Tf 0.0283 Tc 0.1603 Tw (Be as precise as possible when describing the) Tj -0.48 -12 TD 0.058 Tc 0 Tw (location.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc (n) Tj 18.48 -3.12 TD /F1 10.08 Tf 0.0447 Tc -0.2847 Tw (Provide enough information to locate the crash) Tj -0.48 -12 TD 0.0285 Tc -0.0151 Tw (to a specific point, not just a street or roadwa) Tj -1.14 Tc 0 Tw (y.) Tj -18 -24.96 TD /F0 11.04 Tf -0.0261 Tc 1.4261 Tw (Section B: Vehicle ) Tj -0.1517 Tc 1.7117 Tw (You Were Driving) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0481 Tc -0.3281 Tw (Provide information on your license and the) Tj 0 -12 TD -0.0081 Tc -0.2719 Tw (vehicle you were driving.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0011 Tc 0.3589 Tw (Use the codes provided to indicate the cause of) Tj 0 -12 TD 0.1482 Tc -0.0282 Tw (the crash.) Tj -18 -24.96 TD /F0 11.04 Tf -0.017 Tc 1.337 Tw (Section C: ) Tj -0.2255 Tc 1.7855 Tw (You and Your Passengers) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0266 Tc 0.1734 Tw (Provide information on you and your passengers) Tj 0 -12 TD 0.087 Tc -0.399 Tw (at the time of the crash.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.014 Tc 0.506 Tw (Use the codes provided to indicate occupant) Tj 0 -12 TD -0.1165 Tc 0 Tw (information.) Tj -18 -24.96 TD /F0 11.04 Tf 0.0829 Tc 1.5571 Tw (Section D: Other ) Tj -1.0109 Tc 0 Tw (V) Tj 0.0449 Tc 1.6751 Tw (ehicles Involved in the) Tj 0 -13.2 TD 0.2349 Tc 0 Tw (Crash) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0534 Tc -0.5334 Tw (Provide information on the other vehicle\(s\) and) Tj 0 -12 TD 0.069 Tc -0.369 Tw (operator\(s\) involved in the crash.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0064 Tc -0.0921 Tw (If more than one vehicle involved, please use) Tj 0 -12 TD -0.0044 Tc -0.5476 Tw (additional form completing Section D onl) Tj -1.14 Tc 0 Tw (y.) Tj -18 -24.96 TD /F0 11.04 Tf 0.1713 Tc 1.6287 Tw (Section E: Non-Motorist\(s\) Involved) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0339 Tc -0.5739 Tw (Provide information on the non-motorist\(s\)) Tj 0 -12 TD 0.0869 Tc -0.4469 Tw (involved in the crash.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0316 Tc -0.3116 Tw (If more than one non-motorist involved, please) Tj 0 -12 TD 0.0065 Tc -0.5265 Tw (use additional form completing Section E onl) Tj -1.14 Tc 0 Tw (y.) Tj 219.84 438.24 TD /F0 11.04 Tf -0.0036 Tc 1.7236 Tw (Section F: Crash Conditions) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0259 Tc 0.2541 Tw (Use the codes provided to indicate the) Tj 0 -12 TD 0.0659 Tc -0.3059 Tw (conditions at the time of the crash.) Tj -18 -24.96 TD /F0 11.04 Tf -0.0807 Tc 1.6407 Tw (Section G: Crash Diagram) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0478 Tc -0.5792 Tw (Draw a diagram of how the crash occurred.) Tj -18 -8.88 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0963 Tc -0.6163 Tw (On the diagram, ) Tj -1.2778 Tc 0 Tw (V) Tj -0.0177 Tc -0.4223 Tw (ehicle 1 represents your) Tj 0 -12 TD -0.1439 Tc 0 Tw (vehicle.) Tj -18 -24.96 TD /F0 11.04 Tf 0.0238 Tc 1.7762 Tw (Section H: Witness Information) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0291 Tc -0.1758 Tw (List all the people who saw the crash but were) Tj 0 -12 TD 0.0365 Tc 0.3235 Tw (not involved.) Tj -18 -24.96 TD /F0 11.04 Tf -0.0195 Tc 1.6395 Tw (Section I: Property Damage Information) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0606 Tc -0.4686 Tw (Indicate all non-vehicular property that was) Tj 0 -12 TD 0.0968 Tc -0.6168 Tw (damaged in the crash.) Tj -18 -24.96 TD /F0 11.04 Tf 0 Tc 1.656 Tw (Section J: Description of What Happened) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0711 Tc -0.2254 Tw (Describe the crash including events prior to the) Tj 0 -12 TD 0.0462 Tc -0.3376 Tw (crash for your vehicles and all other vehicles.) Tj -18 -24.96 TD /F0 11.04 Tf 0.0281 Tc 1.7719 Tw (Section K: Signature) Tj 0 -9.12 TD /F2 5.28 Tf -0.1042 Tc 0 Tw (n) Tj 18 -3.12 TD /F1 10.08 Tf 0.0827 Tc -0.3827 Tw (Please sign and print your name and indicate the) Tj 0 -12 TD 0.0158 Tc -0.2558 Tw (date you completed the form.) Tj ET 311.76 201.6 m 527.76 201.6 l 527.76 41.76 l 311.76 41.76 l 311.76 201.6 l 312.24 42.24 l 527.28 42.24 l 527.28 200.88 l 312.24 200.88 l 312.24 42.24 l 311.76 201.6 l h f* BT 314.16 190.32 TD /F0 11.04 Tf -0.1017 Tc 1.6883 Tw ( Where to send completed reports:) Tj 18 -23.52 TD /F2 8.88 Tf 0.0079 Tc 0 Tw (q) Tj 18 0 TD /F1 8.88 Tf -0.0745 Tc 1.0045 Tw (Mail or deliver one copy to the local police) Tj 0 -10.8 TD -0.0117 Tc 1.0617 Tw (department or state police in the city or town) Tj T* 0.0071 Tc 0.5729 Tw (where the crash occurred.) Tj -18 -21.6 TD /F2 8.88 Tf 0.0079 Tc 0 Tw (q) Tj 18 0 TD /F1 8.88 Tf 0.0013 Tc 1.1387 Tw (Mail one copy to your Insurance Company.) Tj -18 -21.6 TD /F2 8.88 Tf 0.0079 Tc 0 Tw (q) Tj 18 0 TD /F1 8.88 Tf -0.0099 Tc 0.9399 Tw (Mail one copy to the RMV at the following) Tj 0 -10.8 TD 0.1725 Tc 0 Tw (address:) Tj 36 -10.8 TD 0.0286 Tc 0.8714 Tw (Crash Records) Tj 0 -10.8 TD -0.0436 Tc 1.1836 Tw (Registry of Motor Vehicles) Tj T* -0.8573 Tc 0 Tw (P) Tj 0.0787 Tc 0.2213 Tw (.O. Box 55889) Tj 0 -11.52 TD 0.1069 Tc 0.9131 Tw (Boston, MA 02205-5889) Tj -88.32 -18.48 TD /F1 6 Tf 0.2352 Tc 0.6648 Tw (Page 1) Tj -274.08 1.92 TD 0.171 Tc 0 Tw (CRA-23) Tj ET q 108 0 0 12.24 18.72 759.12 cm /im1 Do endstream endobj 13 0 obj 7989 endobj 15 0 obj << /Type /XObject /Subtype /Image /Name /im1 /Width 450 /Height 51 /BitsPerComponent 8 /ColorSpace [ /Indexed /DeviceRGB 255 14 0 R ] /Length 16 0 R >> stream џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ=!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Jџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Wџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўўџџџџџџџџџЧЧXX!!!!!!Wџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ€!"!""!!!!!! ""џџџџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!‘џџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџџ!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"€џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!"!!!!!!!!!!!!!!!!!!!!!!ёџџџџџџџџџџџџџџџЙ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ўџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! џџџџџџџџџџџџџџџџџџџџџџџџ! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! џџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџЋ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџў !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџ/!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! џџџџџџџџџџ!"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!­џџџџџџџџџџџџџџџџџџџX!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!fџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!"!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!"!!!!!!!!!!!!!!!!џџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Ќџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ "!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџђ!!!!!!!!!!џџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџў!!!!!!!!!!!!!!!ўўџџџџџџџџџџџџ!!!!!!!!!!!!!! џџџџџџџџўџџўџџџџџџџџџџ !!!!!!!!!"џџџџџџџўџџўџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ"!!!!!!!!!€џџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!"џџџџџџџџџџџџџџ!!!!!!!!!!!! !џџџџџџџџџџџџџџџџџў!!!!!!!!!!!!!тџџџџџџџџџџџџџџџџџџџџџ !!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџ !!!!!!!!!!!!џџџџџџџџџџџџџ!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџЌ!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџЧ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ"!!!!!!!! џџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!џџџџџџџџџџџџ!!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџ. !!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџ!!!!!!!!!! џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!Шџџџџџџџџџў.!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!џџџџџџџџџџџџџџџџџџџџ !!!!!!!!!gџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!џџџџџџџџџџЦџџџџџџџ§уџџџџџџ"!!!!!!""!џџџџџџџџџџџџ!!!!!!!!!!tџџџџџџџџџџџџџџџџџџџџўџЧ"!!"!!!" "! "Xўџџџџџџџџџџџџџџџџџџџџџ!!!!""!"!!!!!!=џџџџџџџџџџџџџџўџ !"!!!" 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"!!!џџџџЌ! фџџџўX!!JџџџџџЧ" !ёџџџџџў!џў!!!џџџџџџ!"ўџ"Xўџџџџ!!џџџџџџў!!џџџ!!џўџџџџџџџџ !.џџџџ!!"џџџџџџVЧ#!!Чeёџџџs!џџ"!џџџўџџџ!!Jџџўў"!!џџџё"!!џџџџџџ !!џўџџџџџf!џШ! џџџџ!!!џџўЧ!!ўџџџџџўџџf !ўўџџџџџџ! eџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ!!!!!!!!!!!!!!!!!!џџџџџџџџџџџў!!!!џџ !!!"џџ!!!! !џџ!!!! џ.!!!!џџџ ! !џџџ!!!! џ!!!!!!! џџ!!џџ!!!ў!! !!џџџ!!!!!џ!!!! !!"!!!џ" "!!џџџџџџ!!!ўџџ!!!Jџџ!"!!!еџЧ!!!!!!џџџџ!!!!!џџ!!!!!џ!!!!!џ!!!"!!!џ!!!IџџЌ!! !!џџ!!!!!!!ёџ !! !џџџџџџџ!! !!џџ!!!! Xџџџџџџў!!!џџџ!! !џџ! !!!џџ!!! !!! џџ!! !!џ!!! !!!џџџџ!"!! џџџ!!џ!"!!! !!џt!!!!"џ "!!!"џ!!Чџџ"!!!!дџџ!!!! !!!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџX!!!!!!!!!!!!!!!!!џџџџџџџџџџџџ!!"!"џ!!!!!џџ!!!!!!џ!!!!!"џ !!!!џџ> stream !!!!"!2)B0V7*#oq=*??1B*ZlIG+(/M/S-/h\k20JG180ekF=1,C^B 1c.$H2)R9M2E*QR3&ilX3B9,]3]fDb4?P_h4Zttm5!M7r5X7S#5s[h(6:4+-6psF3 77B[87Ros=84Z9C8P)NH8kVfM9MA,S9heAX:/=Y]:f'tc;,L4h;H$Lm<)cgs$G38>[1N>?!UcC?=.&H?smAN@:EcZ;CFEDVIF`hkNG'A.SG^+IY H$O^^H@(!cI!gLkpkDM2@+I MMmCNN/W^TNK&sYNfT6^OH>QdOcbfiP*;)nPa%DtQ'IZ$QC!r)R$a8/R@0M4R[]e9 S=H+?SXl@DStDXITV.sOTqS3TU8+KYUnjf_V5:&dVPg>iW2QYoWMuntWiN2$XK8M* Xf\b/Y-5%4Yct@:Z*CU?ZEpmD['[3J[C*HO[^W`T\@B&Z\[f;_]">Sd]Y(nj]tM.o ^;%Ft^qdb%_84"*_Sa:/`5KU5`Poj:`lH-?aN2HEaiV]Jb0.uObfn;Uc-=PZcHjh_ d*U.edF$CjdaQ[oeC'm`qYU0er;?KkrVc`prr<#u~> endstream endobj 35 0 obj 990 endobj 38 0 obj << /Length 39 0 R >> stream Q BT 23.28 686.4 TD /F0 10.08 Tf -0.1703 Tc -0.5097 Tw (When Must a Crash Report be filed with the Registrar?) 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Tj -459.12 -17.28 TD -0.0514 Tc 1.1914 Tw (What happened first?) Tj 98.88 0 TD -0.0453 Tc 0.9453 Tw (What happened ) Tj 1.08 Tc 0 Tw (2) Tj 57.6 2.4 TD /F0 4.32 Tf -0.0019 Tc (nd) Tj 4.8 -2.4 TD /F0 7.44 Tf -0.0188 Tc 0.7988 Tw ( \(if applicable\)?) Tj 90.72 0 TD -0.0453 Tc 0.9453 Tw (What happened ) Tj 1.08 Tc 0 Tw (3) Tj 57.6 2.4 TD /F0 4.32 Tf -0.24 Tc (rd) Tj 4.08 -2.4 TD /F0 7.44 Tf -0.0188 Tc 0.9188 Tw ( \(if applicable\)?) Tj 82.32 0 TD -0.3095 Tc 0.6095 Tw (What happened 4) Tj 52.32 2.4 TD /F0 4.32 Tf -0.2402 Tc 0 Tw (th) Tj 3.6 -2.4 TD /F0 7.44 Tf -0.3388 Tc 0.6388 Tw ( \(if applicable\)?) Tj -451.92 -43.68 TD 0.0792 Tc 0.9408 Tw (Collision with) Tj ET 51.84 262.32 45.6 0.72 re f BT 51.84 255.12 TD /F1 7.44 Tf -0.12 Tc -0.06 Tw ( 1) Tj 13.44 0 TD 0.0471 Tc -0.3871 Tw (Motor vehicle in traffic) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 2) Tj 13.44 0 TD 0.071 Tc -0.491 Tw (Parked motor vehicle) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 3) Tj 13.44 0 TD 0.0685 Tc 0 Tw (Pedestrian) Tj -13.44 -8.88 TD -0.12 Tc -0.06 Tw ( 4) Tj 13.44 0 TD -0.1321 Tc 0 Tw (Cyclist) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 5) Tj 13.44 0 TD 0.0726 Tc -0.4926 Tw (Animal- deer) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 6) Tj 13.44 0 TD 0.0194 Tc -0.4394 Tw (Animal- other) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 7) Tj 13.44 0 TD 0.0085 Tc 0 Tw (Moped) Tj -13.44 -8.88 TD -0.12 Tc -0.06 Tw ( 8) Tj 13.44 0 TD 0.0114 Tc -0.3514 Tw (Work zone maintenance equipment) Tj -13.44 -8.64 TD -0.12 Tc -0.06 Tw ( 9) Tj 13.44 0 TD 0.0196 Tc -0.3596 Tw (Railway vehicle \(train, engine\)) Tj -13.44 -8.64 TD -0.6 Tc 0 Tw (10) Tj 13.44 0 TD 0.0518 Tc -0.4718 Tw (Other movable object) Tj -13.44 -8.64 TD -1.08 Tc 0 Tw (11) Tj 13.44 0 TD 0.0025 Tc -0.4225 Tw (Unknown movable object) Tj -13.44 -8.88 TD -0.6 Tc 0 Tw (20) Tj 13.44 0 TD -0.12 Tc (Curb) Tj -13.44 -8.64 TD -0.6 Tc (21) Tj 13.44 0 TD -0.0475 Tc (Tree) Tj -13.44 -8.64 TD -0.6 Tc (22) Tj 13.44 0 TD -0.1386 Tc -0.2814 Tw (Utility pole) Tj ET 372.72 532.56 m 560.64 532.56 l 560.64 510.96 l 372.72 510.96 l 372.72 532.56 l 373.2 511.44 l 560.16 511.44 l 560.16 532.08 l 373.2 532.08 l 373.2 511.44 l 372.72 532.56 l h f* 0.902 0.902 0.902 rg 48.96 722.64 m 559.92 722.64 l 559.92 701.52 l 48.96 701.52 l 48.96 722.64 l h f* 0 0 0 rg 48.48 723.12 m 560.64 723.12 l 560.64 701.04 l 48.48 701.04 l 48.48 723.12 l 49.44 702 l 559.44 702 l 559.44 722.16 l 49.44 722.16 l 49.44 702 l 48.48 723.12 l h f* 48 761.28 m 264 761.28 l 264 739.68 l 48 739.68 l 48 761.28 l 48.72 740.16 l 263.52 740.16 l 263.52 760.8 l 48.72 760.8 l 48.72 740.16 l 48 761.28 l h f* BT 50.4 753.36 TD /F1 6.96 Tf 0.031 Tc 0.869 Tw (City/Town Where Crash Occurred) Tj ET 263.52 761.28 m 390.96 761.28 l 390.96 739.68 l 263.52 739.68 l 263.52 761.28 l 264 740.16 l 390.48 740.16 l 390.48 760.8 l 264 760.8 l 264 740.16 l 263.52 761.28 l h f* BT 265.92 753.36 TD 0.0095 Tc 0.1705 Tw (Date of Crash) Tj ET 390.48 761.28 m 480.48 761.28 l 480.48 739.68 l 390.48 739.68 l 390.48 761.28 l 390.96 740.16 l 480 740.16 l 480 760.8 l 390.96 760.8 l 390.96 740.16 l 390.48 761.28 l h f* BT 392.64 753.36 TD -0.0225 Tc -0.3975 Tw (Time of Crash) Tj 0 -8.4 TD 0.1456 Tc 0.0944 Tw (____ : ____ __ AM __ PM) Tj ET 48.24 772.8 m 560.4 772.8 l 560.4 759.12 l 48.24 759.12 l 48.24 772.8 l h f* 48 773.04 m 560.64 773.04 l 560.64 758.88 l 48 758.88 l 48 773.04 l 48.72 759.36 l 560.16 759.36 l 560.16 772.56 l 48.72 772.56 l 48.72 759.36 l 48 773.04 l h f* BT 235.92 762.24 TD 1 1 1 rg /F0 12 Tf -0.0082 Tc -0.1118 Tw (Section A: Crash Location) Tj 0 0 0 rg ET 480 761.28 m 560.64 761.28 l 560.64 739.68 l 480 739.68 l 480 761.28 l 480.48 740.16 l 560.16 740.16 l 560.16 760.8 l 480.48 760.8 l 480.48 740.16 l 480 761.28 l h f* BT 482.16 753.36 TD /F1 6.96 Tf -0.0526 Tc 0.9526 Tw (# Vehicles) Tj 0 -8.4 TD 0.3425 Tc 0 Tw (Involved:) Tj ET 500.88 609.6 m 501.12 610.32 l 501.84 610.56 l 502.32 610.32 l 502.56 609.6 l 502.32 608.64 l 501.84 608.4 l 501.12 608.64 l 500.88 609.6 l h f* 500.64 609.6 m 500.64 610.08 l 500.88 610.56 l 501.36 610.8 l 502.32 610.8 l 502.56 610.56 l 502.8 610.08 l 502.8 608.88 l 502.56 608.4 l 502.32 608.16 l 501.36 608.16 l 500.88 608.4 l 500.64 608.88 l 500.64 609.6 l 501.12 609.6 l 501.36 608.88 l 501.84 608.64 l 502.08 608.88 l 502.32 609.6 l 502.08 610.08 l 501.84 610.32 l 501.36 610.08 l 501.12 609.6 l 500.64 609.6 l h f* 48.24 564.48 m 560.4 564.48 l 560.4 548.4 l 48.24 548.4 l 48.24 564.48 l h f* 48 564.72 m 560.64 564.72 l 560.64 548.16 l 48 548.16 l 48 564.72 l 48.72 548.64 l 560.16 548.64 l 560.16 564.24 l 48.72 564.24 l 48.72 548.64 l 48 564.72 l h f* BT 217.2 552 TD 1 1 1 rg /F0 11.04 Tf -0.1461 Tc 0.7461 Tw (Section B: Vehicle ) Tj -1.2509 Tc 0 Tw (Y) Tj -0.1964 Tc 0.7964 Tw (ou Were Driving) Tj 0 0 0 rg ET 48 548.4 m 264 548.4 l 264 531.84 l 48 531.84 l 48 548.4 l 48.72 532.32 l 263.52 532.32 l 263.52 547.92 l 48.72 547.92 l 48.72 532.32 l 48 548.4 l h f* BT 50.4 535.92 TD /F0 6.96 Tf 0.0773 Tc 0.2707 Tw (Number of occupants in vehicle \(including yourself\): _________) Tj ET 263.52 548.4 m 560.64 548.4 l 560.64 531.84 l 263.52 531.84 l 263.52 548.4 l 264 532.32 l 560.16 532.32 l 560.16 547.92 l 264 547.92 l 264 532.32 l 263.52 548.4 l h f* BT 265.92 535.92 TD -0.96 Tc 0 Tw (W) Tj 0.0833 Tc 0.1687 Tw (as vehicle damage above $1000? __Yes __No) Tj ET 48 467.52 m 560.64 467.52 l 560.64 410.4 l 48 410.4 l 48 467.52 l 48.72 410.88 l 560.16 410.88 l 560.16 467.04 l 48.72 467.04 l 48.72 410.88 l 48 467.52 l h f* 48 410.64 m 296.4 410.64 l 296.4 388.32 l 48 388.32 l 48 410.64 l 48.72 388.8 l 295.92 388.8 l 295.92 410.16 l 48.72 410.16 l 48.72 388.8 l 48 410.64 l h f* BT 50.4 403.68 TD /F1 6.96 Tf 0.328 Tc 0.4006 Tw (Full Name of Vehicle Owner \(Last, First, Middle\)) Tj ET 295.92 410.64 m 560.64 410.64 l 560.64 388.32 l 295.92 388.32 l 295.92 410.64 l 296.4 388.8 l 560.16 388.8 l 560.16 410.16 l 296.4 410.16 l 296.4 388.8 l 295.92 410.64 l h f* BT 298.08 403.68 TD 0.135 Tc 1.005 Tw (Street Address) Tj 108.24 0 TD 0.1684 Tc 0 Tw (City/Town) Tj 72 0 TD -0.0084 Tc -0.1156 Tw ( State Zip) Tj ET 48 388.8 m 130.8 388.8 l 130.8 342 l 48 342 l 48 388.8 l 48.72 342.48 l 130.32 342.48 l 130.32 388.32 l 48.72 388.32 l 48.72 342.48 l 48 388.8 l h f* 0.902 0.902 0.902 rg 48.24 342.24 m 560.4 342.24 l 560.4 332.4 l 48.24 332.4 l 48.24 342.24 l h f* 0 0 0 rg 48 342.48 m 560.64 342.48 l 560.64 332.16 l 48 332.16 l 48 342.48 l 48.72 332.64 l 560.16 332.64 l 560.16 342 l 48.72 342 l 48.72 332.64 l 48 342.48 l h f* BT 201.84 259.2 TD /F1 7.44 Tf -0.6 Tc 0 Tw (23) Tj 18 0 TD 0.0224 Tc -0.3824 Tw (Light pole or other post/support) Tj -18 -8.88 TD -0.6 Tc 0 Tw (24) Tj 18 0 TD -0.1011 Tc (Guardrail) Tj -18 -8.64 TD -0.6 Tc (25) Tj 18 0 TD 0.031 Tc -0.211 Tw (Median barrier) Tj -18 -8.64 TD -0.6 Tc 0 Tw (26) Tj 18 0 TD 0.0537 Tc (Ditch) Tj -18 -8.64 TD -0.6 Tc (27) Tj 18 0 TD -0.0662 Tc -0.3538 Tw (Embankment/Sloping shoulder) Tj -18 -8.88 TD -0.6 Tc 0 Tw (28) Tj 18 0 TD -0.008 Tc -0.052 Tw (Highway traffic signpost) Tj -18 -8.64 TD -0.6 Tc 0 Tw (29) Tj 18 0 TD 0.0104 Tc -0.1904 Tw (Overhead sign support) Tj -18 -8.64 TD -0.6 Tc 0 Tw (30) Tj 18 0 TD 0.1907 Tc (Fence) Tj -18 -8.64 TD -0.6 Tc (31) Tj 18 0 TD -0.2077 Tc (Mailbox) Tj -18 -8.88 TD -0.6 Tc (32) Tj 18 0 TD 0.0295 Tc 0.1505 Tw (Crash cushion/Impact attenuator) Tj -18 -8.64 TD -0.6 Tc 0 Tw (33) Tj 18 0 TD -0.0953 Tc (Bridge) Tj -18 -8.64 TD -0.6 Tc (34) Tj 18 0 TD 0.0577 Tc -0.2377 Tw (Bridge overhead structure) Tj -18 -8.64 TD -0.6 Tc 0 Tw (35) Tj 18 0 TD -0.0091 Tc -0.4109 Tw (Other fixed object \(wall, building, tunnel\)) Tj -18 -8.88 TD -0.6 Tc 0 Tw (36) Tj 18 0 TD 0.0036 Tc -0.3036 Tw (Unknown fixed object) Tj 162 121.92 TD /F0 7.44 Tf 0.2106 Tc 0 Tw (Non-Collision) Tj ET 381.84 266.4 46.08 0.72 re f BT 381.84 258.96 TD /F1 7.44 Tf -0.6 Tc (40) Tj 18 0 TD 0.0203 Tc -0.0403 Tw (Ran off road right) Tj -18 -8.64 TD -0.6 Tc 0 Tw (41) Tj 18 0 TD 0.0601 Tc -0.0801 Tw (Ran off road left) Tj -18 -8.64 TD -0.6 Tc 0 Tw (42) Tj 18 0 TD 0.0138 Tc -0.1938 Tw (Cross median/centerline) Tj -18 -8.64 TD -0.6 Tc 0 Tw (43) Tj 18 0 TD -0.0095 Tc (Overturn/rollover) Tj -18 -8.88 TD -0.6 Tc (44) Tj 18 0 TD 0.0569 Tc -0.4769 Tw (Equipment failure \(blown tire, brakes, etc\)) Tj -18 -8.64 TD -0.6 Tc 0 Tw (45) Tj 18 0 TD -0.1049 Tc (Fire/explosion) Tj -18 -8.64 TD -0.6 Tc (46) Tj 18 0 TD -0.0886 Tc (Immersion) Tj -18 -8.64 TD -0.6 Tc (47) Tj 18 0 TD -0.0211 Tc (Jackknife) Tj -18 -8.88 TD -0.6 Tc (48) Tj 18 0 TD -0.0041 Tc -0.0959 Tw (Cargo/equipment loss or shift) Tj -18 -8.64 TD -0.6 Tc 0 Tw (49) Tj 18 0 TD 0.0465 Tc -0.4665 Tw (Separation of units) Tj -18 -8.64 TD -0.6 Tc 0 Tw (50) Tj 18 0 TD -0.0296 Tc -0.3904 Tw (Downhill runaway) Tj -18 -8.64 TD -0.6 Tc 0 Tw (51) Tj 18 0 TD -0.0694 Tc -0.3506 Tw (Other non-collision) Tj -18 -8.88 TD -0.6 Tc 0 Tw (52) Tj 18 0 TD -0.1066 Tc -0.3134 Tw (Unknown non-collision) Tj -18 -8.64 TD -0.6 Tc 0 Tw (97) Tj 18 0 TD 0.2118 Tc (Other) Tj -18 -8.64 TD -0.6 Tc (99) Tj 18 0 TD -0.0776 Tc (Unknown) Tj ET 71.76 302.88 m 96.96 302.88 l 96.96 286.56 l 71.76 286.56 l 71.76 302.88 l 72.24 287.04 l 96.48 287.04 l 96.48 302.4 l 72.24 302.4 l 72.24 287.04 l 71.76 302.88 l h f* 187.44 302.88 m 212.64 302.88 l 212.64 286.56 l 187.44 286.56 l 187.44 302.88 l 187.92 287.04 l 212.16 287.04 l 212.16 302.4 l 187.92 302.4 l 187.92 287.04 l 187.44 302.88 l h f* 340.32 302.88 m 365.52 302.88 l 365.52 286.56 l 340.32 286.56 l 340.32 302.88 l 340.8 287.04 l 365.04 287.04 l 365.04 302.4 l 340.8 302.4 l 340.8 287.04 l 340.32 302.88 l h f* 483.84 302.88 m 509.04 302.88 l 509.04 286.56 l 483.84 286.56 l 483.84 302.88 l 484.32 287.04 l 508.56 287.04 l 508.56 302.4 l 484.32 302.4 l 484.32 287.04 l 483.84 302.88 l h f* 48 127.68 m 275.52 127.68 l 275.52 80.88 l 48 80.88 l 48 127.68 l 48.48 81.6 l 274.8 81.6 l 274.8 127.2 l 48.48 127.2 l 48.48 81.6 l 48 127.68 l h f* BT 50.4 102.24 TD /F1 6.96 Tf -0.2979 Tc 0.2379 Tw (Was your ) Tj 26.4 0 TD /F0 6.96 Tf -0.9451 Tc 0 Tw (V) Tj -0.075 Tc -0.225 Tw (ehicle ) Tj -0.1211 Tc 0.0611 Tw (Towed From the Scene Due to Damage?) Tj 137.28 0 TD /F1 6.96 Tf -0.0675 Tc -0.0225 Tw ( __Yes __No) Tj ET 275.04 127.68 m 560.4 127.68 l 560.4 80.88 l 275.04 80.88 l 275.04 127.68 l 275.52 81.6 l 559.92 81.6 l 559.92 127.2 l 275.52 127.2 l 275.52 81.6 l 275.04 127.68 l h f* BT 488.88 117.6 TD -0.0631 Tc 0.4831 Tw (0 None) Tj 0 -8.16 TD 0.0024 Tc 1.1376 Tw (10 Undercarriage) Tj 0 -7.92 TD -0.0425 Tc 0.7025 Tw (11 Totaled) Tj T* 0.0332 Tc 0.8668 Tw (97 Other) Tj 0 -8.16 TD 0.0433 Tc 1.0967 Tw (99 Unknown) Tj ET 422.64 90.48 m 431.52 97.92 l 431.76 97.44 l 422.88 90 l 422.64 90.48 l h f* 442.8 98.4 m 452.64 90.48 l 452.4 90 l 442.32 97.92 l 442.8 98.4 l h f* 442.08 104.16 m 452.16 113.52 l 452.64 113.28 l 442.32 103.92 l 442.08 104.16 l h f* 422.88 113.28 m 432.72 104.16 l 432.24 103.68 l 422.64 113.04 l 422.88 113.28 l h f* 437.52 89.28 m 437.52 114.48 l 438 114.48 l 438 89.28 l 437.52 89.28 l h f* 398.88 111.84 m 401.76 113.76 l 405.12 114.48 l 459.12 114.48 l 462.72 113.76 l 465.6 111.84 l 467.52 108.96 l 468.24 105.36 l 468.24 98.16 l 467.52 94.8 l 465.6 91.92 l 462.72 89.76 l 459.12 89.28 l 405.12 89.28 l 401.76 89.76 l 398.88 91.92 l 396.72 94.8 l 396.24 98.16 l 396.24 105.36 l 396.72 108.96 l 398.88 111.84 l 399.12 111.36 l 397.2 108.72 l 396.72 105.36 l 396.72 98.16 l 397.2 95.04 l 399.12 92.16 l 402 90.24 l 405.12 89.76 l 459.12 89.76 l 462.48 90.24 l 465.12 92.16 l 467.04 95.04 l 467.76 98.16 l 467.76 105.36 l 467.04 108.72 l 465.12 111.36 l 462.48 113.28 l 459.12 114 l 405.12 114 l 402 113.28 l 399.12 111.36 l 398.88 111.84 l h f* 422.64 113.04 m 424.08 114 l 425.76 114.48 l 449.28 114.48 l 451.2 114 l 452.64 113.04 l 453.6 111.6 l 453.84 109.92 l 453.84 93.6 l 453.6 91.92 l 452.64 90.48 l 451.2 89.52 l 449.28 89.28 l 425.76 89.28 l 424.08 89.52 l 422.64 90.48 l 421.68 91.92 l 421.2 93.6 l 421.2 109.92 l 421.68 111.6 l 422.64 113.04 l 422.88 112.8 l 422.16 111.36 l 421.68 109.92 l 421.68 93.6 l 422.16 92.16 l 422.88 90.96 l 424.32 90 l 425.76 89.76 l 449.28 89.76 l 450.96 90 l 452.16 90.96 l 453.12 92.16 l 453.36 93.6 l 453.36 109.92 l 453.12 111.36 l 452.16 112.8 l 450.96 113.52 l 449.28 114 l 425.76 114 l 424.32 113.52 l 422.88 112.8 l 422.64 113.04 l h f* 1 1 1 rg 431.76 104.64 m 443.28 104.64 l 443.28 97.68 l 431.76 97.68 l 431.76 104.64 l h f* 0 0 0 rg 431.52 104.88 m 443.52 104.88 l 443.52 97.44 l 431.52 97.44 l 431.52 104.88 l 432 97.92 l 443.04 97.92 l 443.04 104.4 l 432 104.4 l 432 97.92 l 431.52 104.88 l h f* BT 390.96 81.84 TD 0.12 Tc 0 Tw (8) Tj 36 0 TD -0.12 Tc 0.108 Tw ( 7) Tj 38.64 0 TD -0.36 Tc 0.22 Tw ( 6) Tj -74.64 34.8 TD 0.12 Tc 0 Tw (2) Tj 36 0 TD -0.12 Tc 0.108 Tw ( 3) Tj 38.64 0 TD -0.36 Tc 0.22 Tw ( 4) Tj ET 402.72 100.56 m 414.24 100.56 l 414.24 100.08 l 402.72 100.08 l 402.72 100.56 l h f* 406.56 98.64 m 401.04 100.56 l 406.56 102.48 l 406.56 98.64 l h f* 406.32 98.4 m 401.04 100.32 l 400.32 100.56 l 401.04 100.8 l 401.04 100.56 l 401.04 100.8 l 406.56 98.88 l 406.56 98.64 l 406.32 98.4 l h f* 401.04 100.8 m 406.32 102.72 l 406.8 102.96 l 406.8 102.48 l 406.56 102.48 l 406.56 102.24 l 401.04 100.32 l 401.04 100.8 l h f* 406.8 102.48 m 406.8 98.4 l 406.32 98.4 l 406.56 98.64 l 406.08 98.64 l 406.08 102.48 l 406.8 102.48 l h f* BT 390.96 98.88 TD 0.12 Tc 0 Tw (1) Tj 36 0 TD -0.12 Tc 0.108 Tw ( 9) Tj 38.64 0 TD -0.36 Tc 0.22 Tw ( 5) Tj 0.8 0.8 0.8 rg ET 48.24 532.32 m 155.76 532.32 l 155.76 511.2 l 48.24 511.2 l 48.24 532.32 l h f* 0 0 0 rg 48 532.56 m 156 532.56 l 156 510.96 l 48 510.96 l 48 532.56 l 48.72 511.44 l 155.52 511.44 l 155.52 532.08 l 48.72 532.08 l 48.72 511.44 l 48 532.56 l h f* BT 50.4 525.36 TD 0.116 Tc 0.904 Tw (Driver\222s License Number) Tj ET 155.52 532.56 m 198.72 532.56 l 198.72 510.96 l 155.52 510.96 l 155.52 532.56 l 156 511.44 l 198.24 511.44 l 198.24 532.08 l 156 532.08 l 156 511.44 l 155.52 532.56 l h f* BT 157.92 525.36 TD -0.0638 Tc 0.9638 Tw (License State) Tj ET 240.96 532.56 m 258.96 532.56 l 258.96 510.96 l 240.96 510.96 l 240.96 532.56 l 241.44 511.44 l 258.48 511.44 l 258.48 532.08 l 241.44 532.08 l 241.44 511.44 l 240.96 532.56 l h f* BT 243.36 525.36 TD 0.1349 Tc 0 Tw (Age) Tj ET 258.48 532.56 m 294.48 532.56 l 294.48 510.96 l 258.48 510.96 l 258.48 532.56 l 258.96 511.44 l 294 511.44 l 294 532.08 l 258.96 532.08 l 258.96 511.44 l 258.48 532.56 l h f* BT 260.88 525.36 TD -0.2 Tc (Sex) Tj 0 -7.68 TD /F1 6 Tf 0.155 Tc -0.275 Tw (__ M __ F) Tj ET 294.24 532.56 m 373.2 532.56 l 373.2 510.96 l 294.24 510.96 l 294.24 532.56 l 294.72 511.44 l 372.72 511.44 l 372.72 532.08 l 294.72 532.08 l 294.72 511.44 l 294.24 532.56 l h f* 198.24 532.56 m 241.44 532.56 l 241.44 510.96 l 198.24 510.96 l 198.24 532.56 l 198.72 511.44 l 240.96 511.44 l 240.96 532.08 l 198.72 532.08 l 198.72 511.44 l 198.24 532.56 l h f* BT 200.64 525.36 TD /F1 6.96 Tf 0.032 Tc 0.148 Tw (Date of Birth) Tj ET 48 489.36 m 224.4 489.36 l 224.4 467.04 l 48 467.04 l 48 489.36 l 48.72 467.52 l 223.92 467.52 l 223.92 488.88 l 48.72 488.88 l 48.72 467.52 l 48 489.36 l h f* BT 50.4 482.16 TD 0.0824 Tc 1.0576 Tw (Insurance Company) Tj 0.8 0.8 0.8 rg ET 224.16 489.12 m 320.88 489.12 l 320.88 467.28 l 224.16 467.28 l 224.16 489.12 l h f* 0 0 0 rg 223.92 489.36 m 321.12 489.36 l 321.12 467.04 l 223.92 467.04 l 223.92 489.36 l 224.4 467.52 l 320.64 467.52 l 320.64 488.88 l 224.4 488.88 l 224.4 467.52 l 223.92 489.36 l h f* BT 1.2042 0 0 1 226.08 482.16 Tm -0.3665 Tc 0 Tw (V) Tj 0.4309 Tc 0.8231 Tw (ehicle Registration ) Tj 1.2476 Tc 0 Tw (#) Tj ET 320.4 489.36 m 367.2 489.36 l 367.2 467.04 l 320.4 467.04 l 320.4 489.36 l 320.88 467.52 l 366.72 467.52 l 366.72 488.88 l 320.88 488.88 l 320.88 467.52 l 320.4 489.36 l h f* BT 322.8 482.16 TD -0.1369 Tc 0.5569 Tw (Reg. Type) Tj ET 366.96 489.36 m 413.76 489.36 l 413.76 467.04 l 366.96 467.04 l 366.96 489.36 l 367.44 467.52 l 413.28 467.52 l 413.28 488.88 l 367.44 488.88 l 367.44 467.52 l 366.96 489.36 l h f* BT 369.12 482.16 TD -0.0258 Tc 0.9258 Tw (Reg. 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Tj 0 -6.96 TD -0.0914 Tc 0.7154 Tw (If you need additional space to describe the crash location, please use Section J on the last page of this form.) 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Tj -27.12 -19.2 TD /F1 7.44 Tf 0.1983 Tc -0.3383 Tw (____________ __________________________________) Tj 0 -8.88 TD 0.0421 Tc 0.4079 Tw (Route# Name of Roadway/Street) Tj 0 -18 TD 0.1983 Tc -0.3383 Tw (____________ __________________________________) Tj 0 -9.12 TD 0.0421 Tc 0.4079 Tw (Route# Name of Roadway/Street) Tj 199.2 127.68 TD /F0 10.08 Tf 0.12 Tc 0 Tw (OR) Tj ET 250.08 706.56 15.12 0.96 re f BT 50.4 459.84 TD /F0 7.44 Tf 0.0153 Tc 1.1247 Tw (Indicate your type of vehicle) Tj 0 -18.24 TD /F1 7.44 Tf 0 Tc 0.06 Tw ( ) Tj 2.16 1.44 TD 0.0679 Tc 0.4721 Tw (1 Passenger car) Tj 96.72 0 TD -0.022 Tc 0.482 Tw (4 Bus \(15 or more passengers\)) Tj 117.12 0 TD 0.12 Tc -0.3 Tw (8 ) Tj 8.64 0 TD 0.006 Tc 0 Tw (Truck/trailer) Tj 81.36 0 TD 0.0656 Tc -0.6056 Tw (12 Tractor/triples) Tj 126 0 TD 0.1513 Tc -0.3313 Tw (97 Other) Tj -432 -9.36 TD 0.0489 Tc -0.4003 Tw ( 2 Light truck \(van, mini-van,) Tj 98.88 0 TD 0.006 Tc 0.414 Tw (5 Bus \(7-15 passengers\)) Tj 117.12 0 TD 0.12 Tc -0.14 Tw (9 ) Tj 8.88 0 TD -0.1453 Tc 0 Tw (Truck) Tj 16.8 0 TD 0.0049 Tc -0.1849 Tw ( tractor \(bobtail\)) Tj 64.32 0 TD 0.0506 Tc -0.1106 Tw (13 Unknown heavy truck) Tj 126 0 TD -0.007 Tc -0.053 Tw (99 Unknown) Tj -432 -9.6 TD 0.0701 Tc -0.3401 Tw ( pick-up, sport utility\)) Tj 98.88 0 TD 0.0398 Tc -0.3638 Tw (6 Single-unit truck \(2 axles\)) Tj 117.12 0 TD 0.0244 Tc -0.4444 Tw (10 Tractor/semi-trailer) Tj 90 0 TD 0.0554 Tc -0.4154 Tw (14 Motor home/recreational vehicle) Tj -306 -9.36 TD 0.1001 Tc -0.2201 Tw ( 3 Motorcycle) Tj 98.88 0 TD 0.12 Tc -0.3 Tw (7 ) Tj 7.2 0 TD -0.111 Tc -0.229 Tw (Single-unit truck \(3 or more axles\)) Tj 109.92 0 TD -0.0041 Tc -0.6559 Tw (11 Tractor/doubles) Tj -133.44 -34.08 TD /F0 7.44 Tf -0.1234 Tc 1.1134 Tw (What Was Your Vehicle Doing Prior to the Crash?) 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652.56 l h f* 171.36 620.64 m 348 620.64 l 348 608.64 l 171.36 608.64 l 171.36 620.64 l 171.84 609.12 l 347.52 609.12 l 347.52 620.16 l 171.84 620.16 l 171.84 609.12 l 171.36 620.64 l h f* BT 246.24 646.8 TD 0.5074 Tc (Address) Tj -72 -12 TD 0.1951 Tc (City/Town) Tj 108 0 TD 0.336 Tc (State) Tj 43.44 0 TD 0.2309 Tc (Zip) Tj -79.44 -19.2 TD 0.5074 Tc (Address) Tj -72 -12 TD 0.1951 Tc (City/Town) Tj 108 0 TD 0.336 Tc (State) Tj 43.44 0 TD 0.2309 Tc (Zip) Tj 0.498 0.498 0.498 rg ET 176.4 712.32 m 176.4 712.56 176.16 712.8 175.92 712.8 c 175.68 712.8 175.44 712.56 175.44 712.32 c 175.44 712.32 175.68 712.08 175.92 712.08 c 176.16 712.08 176.4 712.32 176.4 712.32 c h f* 181.44 712.32 m 181.44 712.56 181.2 712.8 180.96 712.8 c 180.72 712.8 180.48 712.56 180.48 712.32 c 180.48 712.32 180.72 712.08 180.96 712.08 c 181.2 712.08 181.44 712.32 181.44 712.32 c h f* 186.48 712.32 m 186.48 712.56 186.24 712.8 186 712.8 c 185.76 712.8 185.52 712.56 185.52 712.32 c 185.52 712.32 185.76 712.08 186 712.08 c 186.24 712.08 186.48 712.32 186.48 712.32 c h f* 191.28 712.32 m 191.28 712.56 191.28 712.8 191.04 712.8 c 190.8 712.8 190.56 712.56 190.56 712.32 c 190.56 712.32 190.8 712.08 191.04 712.08 c 191.28 712.08 191.28 712.32 191.28 712.32 c h f* 196.32 712.32 m 196.32 712.56 196.32 712.8 196.08 712.8 c 195.84 712.8 195.6 712.56 195.6 712.32 c 195.6 712.32 195.84 712.08 196.08 712.08 c 196.32 712.08 196.32 712.32 196.32 712.32 c h f* 201.36 712.32 m 201.36 712.56 201.36 712.8 201.12 712.8 c 200.88 712.8 200.64 712.56 200.64 712.32 c 200.64 712.32 200.88 712.08 201.12 712.08 c 201.36 712.08 201.36 712.32 201.36 712.32 c h f* 206.4 712.32 m 206.4 712.56 206.4 712.8 206.16 712.8 c 205.92 712.8 205.68 712.56 205.68 712.32 c 205.68 712.32 205.92 712.08 206.16 712.08 c 206.4 712.08 206.4 712.32 206.4 712.32 c h f* 211.44 712.32 m 211.44 712.56 211.44 712.8 211.2 712.8 c 210.96 712.8 210.72 712.56 210.72 712.32 c 210.72 712.32 210.96 712.08 211.2 712.08 c 211.44 712.08 211.44 712.32 211.44 712.32 c h f* 216.48 712.32 m 216.48 712.56 216.48 712.8 216.24 712.8 c 216 712.8 215.76 712.56 215.76 712.32 c 215.76 712.32 216 712.08 216.24 712.08 c 216.48 712.08 216.48 712.32 216.48 712.32 c h f* 221.52 712.32 m 221.52 712.56 221.52 712.8 221.28 712.8 c 221.04 712.8 220.8 712.56 220.8 712.32 c 220.8 712.32 221.04 712.08 221.28 712.08 c 221.52 712.08 221.52 712.32 221.52 712.32 c h f* 226.56 712.32 m 226.56 712.56 226.56 712.8 226.32 712.8 c 226.08 712.8 225.84 712.56 225.84 712.32 c 225.84 712.32 226.08 712.08 226.32 712.08 c 226.56 712.08 226.56 712.32 226.56 712.32 c h f* 231.6 712.32 m 231.6 712.56 231.6 712.8 231.36 712.8 c 231.12 712.8 230.88 712.56 230.88 712.32 c 230.88 712.32 231.12 712.08 231.36 712.08 c 231.6 712.08 231.6 712.32 231.6 712.32 c h f* 236.64 712.32 m 236.64 712.56 236.64 712.8 236.4 712.8 c 236.16 712.8 235.92 712.56 235.92 712.32 c 235.92 712.32 236.16 712.08 236.4 712.08 c 236.64 712.08 236.64 712.32 236.64 712.32 c h f* 241.68 712.32 m 241.68 712.56 241.68 712.8 241.44 712.8 c 241.2 712.8 240.96 712.56 240.96 712.32 c 240.96 712.32 241.2 712.08 241.44 712.08 c 241.68 712.08 241.68 712.32 241.68 712.32 c h f* 246.72 712.32 m 246.72 712.56 246.72 712.8 246.48 712.8 c 246.24 712.8 246 712.56 246 712.32 c 246 712.32 246.24 712.08 246.48 712.08 c 246.72 712.08 246.72 712.32 246.72 712.32 c h f* 251.76 712.32 m 251.76 712.56 251.76 712.8 251.52 712.8 c 251.28 712.8 251.04 712.56 251.04 712.32 c 251.04 712.32 251.28 712.08 251.52 712.08 c 251.76 712.08 251.76 712.32 251.76 712.32 c h f* 256.8 712.32 m 256.8 712.56 256.8 712.8 256.56 712.8 c 256.32 712.8 256.08 712.56 256.08 712.32 c 256.08 712.32 256.32 712.08 256.56 712.08 c 256.8 712.08 256.8 712.32 256.8 712.32 c h f* 261.84 712.32 m 261.84 712.56 261.84 712.8 261.6 712.8 c 261.36 712.8 261.12 712.56 261.12 712.32 c 261.12 712.32 261.36 712.08 261.6 712.08 c 261.84 712.08 261.84 712.32 261.84 712.32 c h f* 266.88 712.32 m 266.88 712.56 266.88 712.8 266.64 712.8 c 266.4 712.8 266.16 712.56 266.16 712.32 c 266.16 712.32 266.4 712.08 266.64 712.08 c 266.88 712.08 266.88 712.32 266.88 712.32 c h f* 271.92 712.32 m 271.92 712.56 271.68 712.8 271.44 712.8 c 271.2 712.8 270.96 712.56 270.96 712.32 c 270.96 712.32 271.2 712.08 271.44 712.08 c 271.68 712.08 271.92 712.32 271.92 712.32 c h f* 276.96 712.32 m 276.96 712.56 276.72 712.8 276.48 712.8 c 276.24 712.8 276 712.56 276 712.32 c 276 712.32 276.24 712.08 276.48 712.08 c 276.72 712.08 276.96 712.32 276.96 712.32 c h f* 282 712.32 m 282 712.56 281.76 712.8 281.52 712.8 c 281.28 712.8 281.04 712.56 281.04 712.32 c 281.04 712.32 281.28 712.08 281.52 712.08 c 281.76 712.08 282 712.32 282 712.32 c h f* 286.8 712.32 m 286.8 712.56 286.8 712.8 286.56 712.8 c 286.32 712.8 286.08 712.56 286.08 712.32 c 286.08 712.32 286.32 712.08 286.56 712.08 c 286.8 712.08 286.8 712.32 286.8 712.32 c h f* 291.84 712.32 m 291.84 712.56 291.84 712.8 291.6 712.8 c 291.36 712.8 291.12 712.56 291.12 712.32 c 291.12 712.32 291.36 712.08 291.6 712.08 c 291.84 712.08 291.84 712.32 291.84 712.32 c h f* 296.88 712.32 m 296.88 712.56 296.88 712.8 296.64 712.8 c 296.4 712.8 296.16 712.56 296.16 712.32 c 296.16 712.32 296.4 712.08 296.64 712.08 c 296.88 712.08 296.88 712.32 296.88 712.32 c h f* 301.92 712.32 m 301.92 712.56 301.92 712.8 301.68 712.8 c 301.44 712.8 301.2 712.56 301.2 712.32 c 301.2 712.32 301.44 712.08 301.68 712.08 c 301.92 712.08 301.92 712.32 301.92 712.32 c h f* 306.96 712.32 m 306.96 712.56 306.96 712.8 306.72 712.8 c 306.48 712.8 306.24 712.56 306.24 712.32 c 306.24 712.32 306.48 712.08 306.72 712.08 c 306.96 712.08 306.96 712.32 306.96 712.32 c h f* 312 712.32 m 312 712.56 312 712.8 311.76 712.8 c 311.52 712.8 311.28 712.56 311.28 712.32 c 311.28 712.32 311.52 712.08 311.76 712.08 c 312 712.08 312 712.32 312 712.32 c h f* 317.04 712.32 m 317.04 712.56 317.04 712.8 316.8 712.8 c 316.56 712.8 316.32 712.56 316.32 712.32 c 316.32 712.32 316.56 712.08 316.8 712.08 c 317.04 712.08 317.04 712.32 317.04 712.32 c h f* 322.08 712.32 m 322.08 712.56 322.08 712.8 321.84 712.8 c 321.6 712.8 321.36 712.56 321.36 712.32 c 321.36 712.32 321.6 712.08 321.84 712.08 c 322.08 712.08 322.08 712.32 322.08 712.32 c h f* 327.12 712.32 m 327.12 712.56 327.12 712.8 326.88 712.8 c 326.64 712.8 326.4 712.56 326.4 712.32 c 326.4 712.32 326.64 712.08 326.88 712.08 c 327.12 712.08 327.12 712.32 327.12 712.32 c h f* 332.16 712.32 m 332.16 712.56 332.16 712.8 331.92 712.8 c 331.68 712.8 331.44 712.56 331.44 712.32 c 331.44 712.32 331.68 712.08 331.92 712.08 c 332.16 712.08 332.16 712.32 332.16 712.32 c h f* 337.2 712.32 m 337.2 712.56 337.2 712.8 336.96 712.8 c 336.72 712.8 336.48 712.56 336.48 712.32 c 336.48 712.32 336.72 712.08 336.96 712.08 c 337.2 712.08 337.2 712.32 337.2 712.32 c h f* 342.24 712.32 m 342.24 712.56 342.24 712.8 342 712.8 c 341.76 712.8 341.52 712.56 341.52 712.32 c 341.52 712.32 341.76 712.08 342 712.08 c 342.24 712.08 342.24 712.32 342.24 712.32 c h f* 347.28 712.32 m 347.28 712.56 347.28 712.8 347.04 712.8 c 346.8 712.8 346.56 712.56 346.56 712.32 c 346.56 712.32 346.8 712.08 347.04 712.08 c 347.28 712.08 347.28 712.32 347.28 712.32 c h f* 352.32 712.32 m 352.32 712.56 352.32 712.8 352.08 712.8 c 351.84 712.8 351.6 712.56 351.6 712.32 c 351.6 712.32 351.84 712.08 352.08 712.08 c 352.32 712.08 352.32 712.32 352.32 712.32 c h f* 357.36 712.32 m 357.36 712.56 357.36 712.8 357.12 712.8 c 356.88 712.8 356.64 712.56 356.64 712.32 c 356.64 712.32 356.88 712.08 357.12 712.08 c 357.36 712.08 357.36 712.32 357.36 712.32 c h f* 362.4 712.32 m 362.4 712.56 362.16 712.8 361.92 712.8 c 361.68 712.8 361.44 712.56 361.44 712.32 c 361.44 712.32 361.68 712.08 361.92 712.08 c 362.16 712.08 362.4 712.32 362.4 712.32 c h f* 367.44 712.32 m 367.44 712.56 367.2 712.8 366.96 712.8 c 366.72 712.8 366.48 712.56 366.48 712.32 c 366.48 712.32 366.72 712.08 366.96 712.08 c 367.2 712.08 367.44 712.32 367.44 712.32 c h f* 372.48 712.32 m 372.48 712.56 372.24 712.8 372 712.8 c 371.76 712.8 371.52 712.56 371.52 712.32 c 371.52 712.32 371.76 712.08 372 712.08 c 372.24 712.08 372.48 712.32 372.48 712.32 c h f* 377.28 712.32 m 377.28 712.56 377.28 712.8 377.04 712.8 c 376.8 712.8 376.56 712.56 376.56 712.32 c 376.56 712.32 376.8 712.08 377.04 712.08 c 377.28 712.08 377.28 712.32 377.28 712.32 c h f* 382.32 712.32 m 382.32 712.56 382.32 712.8 382.08 712.8 c 381.84 712.8 381.6 712.56 381.6 712.32 c 381.6 712.32 381.84 712.08 382.08 712.08 c 382.32 712.08 382.32 712.32 382.32 712.32 c h f* 387.36 712.32 m 387.36 712.56 387.36 712.8 387.12 712.8 c 386.88 712.8 386.64 712.56 386.64 712.32 c 386.64 712.32 386.88 712.08 387.12 712.08 c 387.36 712.08 387.36 712.32 387.36 712.32 c h f* 392.4 712.32 m 392.4 712.56 392.4 712.8 392.16 712.8 c 391.92 712.8 391.68 712.56 391.68 712.32 c 391.68 712.32 391.92 712.08 392.16 712.08 c 392.4 712.08 392.4 712.32 392.4 712.32 c h f* 397.44 712.32 m 397.44 712.56 397.44 712.8 397.2 712.8 c 396.96 712.8 396.72 712.56 396.72 712.32 c 396.72 712.32 396.96 712.08 397.2 712.08 c 397.44 712.08 397.44 712.32 397.44 712.32 c h f* 402.48 712.32 m 402.48 712.56 402.48 712.8 402.24 712.8 c 402 712.8 401.76 712.56 401.76 712.32 c 401.76 712.32 402 712.08 402.24 712.08 c 402.48 712.08 402.48 712.32 402.48 712.32 c h f* 407.52 712.32 m 407.52 712.56 407.52 712.8 407.28 712.8 c 407.04 712.8 406.8 712.56 406.8 712.32 c 406.8 712.32 407.04 712.08 407.28 712.08 c 407.52 712.08 407.52 712.32 407.52 712.32 c h f* BT 199.2 583.44 TD 0 0 0 rg /F1 6.48 Tf 0.12 Tc (9) Tj 11.28 0 TD 0.0471 Tc 0.3129 Tw (Third row - right side) Tj -11.28 -9.6 TD -0.6 Tc 0 Tw (10) Tj 11.28 0 TD 0.1209 Tc 0.2591 Tw (Sleeper section of cab) Tj -11.28 -9.84 TD -0.6 Tc 0 Tw (11) Tj 11.28 0 TD 0.144 Tc 0.756 Tw (Enclosed passenger area) Tj -11.28 -9.6 TD -0.6 Tc 0 Tw (12) Tj 11.28 0 TD 0.1473 Tc 0.9927 Tw (Unenclosed passenger area) Tj -11.28 -9.84 TD -0.6 Tc 0 Tw (13) Tj 11.28 0 TD 0.0399 Tc 0.2601 Tw (Trailing unit) Tj -11.28 -9.6 TD -0.6 Tc 0 Tw (14) Tj 11.28 0 TD 0.0577 Tc 0.2423 Tw (Riding on vehicle exterior) Tj -11.28 -9.6 TD -0.6 Tc 0 Tw (97) Tj 11.28 0 TD 0.217 Tc (Other) Tj -11.28 -9.84 TD -0.6 Tc (99) Tj 11.28 0 TD 0.1204 Tc (Unknown) Tj ET 39.12 365.04 m 575.52 365.04 l 575.52 307.68 l 39.12 307.68 l 39.12 365.04 l 39.6 308.16 l 575.04 308.16 l 575.04 364.56 l 39.6 364.56 l 39.6 308.16 l 39.12 365.04 l h f* 39.12 308.4 m 311.28 308.4 l 311.28 286.08 l 39.12 286.08 l 39.12 308.4 l 39.6 286.56 l 310.8 286.56 l 310.8 307.68 l 39.6 307.68 l 39.6 286.56 l 39.12 308.4 l h f* BT 41.52 300.72 TD /F1 7.44 Tf 0.0555 Tc 0.3474 Tw (Full Name of Vehicle Owner \(Last, First, Middle\)) Tj ET 310.8 308.4 m 575.52 308.4 l 575.52 286.08 l 310.8 286.08 l 310.8 308.4 l 311.28 286.56 l 575.04 286.56 l 575.04 307.68 l 311.28 307.68 l 311.28 286.56 l 310.8 308.4 l h f* BT 313.2 301.2 TD /F1 6.96 Tf 0.135 Tc 1.005 Tw (Street Address) Tj 108 0 TD 0.1684 Tc 0 Tw (City/Town) Tj 72 0 TD -0 Tc 0.3 Tw ( State) Tj 36 0 TD -0.0225 Tc -0.0718 Tw ( Zip) Tj ET 39.12 286.56 m 89.52 286.56 l 89.52 239.76 l 39.12 239.76 l 39.12 286.56 l 39.6 240.24 l 89.04 240.24 l 89.04 285.84 l 39.6 285.84 l 39.6 240.24 l 39.12 286.56 l h f* BT 43.68 279.36 TD -0.7051 Tc 0 Tw (V) Tj 0.0212 Tc 0.8788 Tw (ehicle Travel) Tj 0 -8.4 TD 0.3058 Tc 0 Tw (Direction) Tj 0 -16.8 TD 0.1975 Tc 0.4625 Tw (__N __S) Tj 0 -8.4 TD 0.2362 Tc 0.9038 Tw (__E __W) Tj 0.8 0.8 0.8 rg ET 39.36 429.84 m 170.88 429.84 l 170.88 408.72 l 39.36 408.72 l 39.36 429.84 l h f* 0 0 0 rg 39.12 430.08 m 171.12 430.08 l 171.12 408.48 l 39.12 408.48 l 39.12 430.08 l 39.6 408.96 l 170.64 408.96 l 170.64 429.6 l 39.6 429.6 l 39.6 408.96 l 39.12 430.08 l h f* BT 41.52 422.88 TD 0.116 Tc 0.904 Tw (Driver\222s License Number) Tj ET 39.12 386.88 m 233.52 386.88 l 233.52 364.8 l 39.12 364.8 l 39.12 386.88 l 39.6 365.28 l 233.04 365.28 l 233.04 386.4 l 39.6 386.4 l 39.6 365.28 l 39.12 386.88 l h f* BT 41.52 379.92 TD 0.0824 Tc 1.0576 Tw (Insurance Company) Tj 0.8 0.8 0.8 rg ET 233.28 386.64 m 336 386.64 l 336 365.04 l 233.28 365.04 l 233.28 386.64 l h f* 0 0 0 rg 233.04 386.88 m 336.24 386.88 l 336.24 364.8 l 233.04 364.8 l 233.04 386.88 l 233.52 365.28 l 335.76 365.28 l 335.76 386.4 l 233.52 386.4 l 233.52 365.28 l 233.04 386.88 l h f* BT 235.2 379.44 TD /F1 7.44 Tf 0.4024 Tc 0.4976 Tw (Vehicle Registration #) Tj ET 335.52 386.88 m 382.32 386.88 l 382.32 364.8 l 335.52 364.8 l 335.52 386.88 l 336 365.28 l 381.84 365.28 l 381.84 386.4 l 336 386.4 l 336 365.28 l 335.52 386.88 l h f* BT 337.92 379.92 TD /F1 6.96 Tf -0.1369 Tc 0.5569 Tw (Reg. Type) Tj ET 381.84 386.88 m 428.64 386.88 l 428.64 364.8 l 381.84 364.8 l 381.84 386.88 l 382.56 365.28 l 428.16 365.28 l 428.16 386.4 l 382.56 386.4 l 382.56 365.28 l 381.84 386.88 l h f* BT 384.24 379.92 TD -0.0258 Tc 0.9258 Tw (Reg. State) Tj ET 428.16 386.88 m 489.36 386.88 l 489.36 364.8 l 428.16 364.8 l 428.16 386.88 l 428.64 365.28 l 488.88 365.28 l 488.88 386.4 l 428.64 386.4 l 428.64 365.28 l 428.16 386.88 l h f* BT 430.56 379.92 TD -0.7051 Tc 0 Tw (V) Tj -0.0384 Tc 0.2184 Tw (ehicle Year) Tj ET 488.88 386.88 m 575.52 386.88 l 575.52 364.8 l 488.88 364.8 l 488.88 386.88 l 489.6 365.28 l 575.04 365.28 l 575.04 386.4 l 489.6 386.4 l 489.6 365.28 l 488.88 386.88 l h f* BT 491.28 379.92 TD -0.7051 Tc 0 Tw (V) Tj 0.0172 Tc 0.1628 Tw (ehicle Make) Tj ET 170.4 430.08 m 213.6 430.08 l 213.6 408.48 l 170.4 408.48 l 170.4 430.08 l 171.12 408.96 l 213.12 408.96 l 213.12 429.6 l 171.12 429.6 l 171.12 408.96 l 170.4 430.08 l h f* BT 172.8 422.88 TD -0.0638 Tc 0.9638 Tw (License State) Tj ET 256.08 430.08 m 274.08 430.08 l 274.08 408.48 l 256.08 408.48 l 256.08 430.08 l 256.56 408.96 l 273.6 408.96 l 273.6 429.6 l 256.56 429.6 l 256.56 408.96 l 256.08 430.08 l h f* BT 258.24 422.88 TD 0.1349 Tc 0 Tw (Age) Tj ET 213.36 430.08 m 256.56 430.08 l 256.56 408.48 l 213.36 408.48 l 213.36 430.08 l 213.84 408.96 l 255.84 408.96 l 255.84 429.6 l 213.84 429.6 l 213.84 408.96 l 213.36 430.08 l h f* BT 215.52 422.88 TD 0.032 Tc 0.148 Tw (Date of Birth) Tj ET 39.12 408.96 m 233.52 408.96 l 233.52 386.64 l 39.12 386.64 l 39.12 408.96 l 39.6 387.12 l 233.04 387.12 l 233.04 408.48 l 39.6 408.48 l 39.6 387.12 l 39.12 408.96 l h f* BT 41.52 401.28 TD /F1 7.44 Tf 0.2109 Tc 0.3633 Tw (Full Name of Vehicle Driver \(Last, First, Middle\)) Tj ET 233.04 408.96 m 575.52 408.96 l 575.52 386.64 l 233.04 386.64 l 233.04 408.96 l 233.52 387.12 l 575.04 387.12 l 575.04 408.48 l 233.52 408.48 l 233.52 387.12 l 233.04 408.96 l h f* BT 235.2 401.76 TD /F1 6.96 Tf 0.135 Tc 1.005 Tw (Street Address) Tj 144 0 TD 0.1684 Tc 0 Tw (City/Town) Tj 108 0 TD -0 Tc -0.012 Tw ( State) Tj 36 0 TD -0.0225 Tc -0.0975 Tw ( Zip) Tj ET 39.36 239.76 m 575.28 239.76 l 575.28 226.08 l 39.36 226.08 l 39.36 239.76 l h f* 39.12 240 m 575.52 240 l 575.52 225.84 l 39.12 225.84 l 39.12 240 l 39.6 226.32 l 575.04 226.32 l 575.04 239.52 l 39.6 239.52 l 39.6 226.32 l 39.12 240 l h f* BT 180 229.44 TD 1 1 1 rg /F0 12 Tf -0.0111 Tc -0.1889 Tw (Section E: Non-Motorist\(s\) Involved in the Crash) Tj 0 0 0 rg ET 39.12 147.6 m 100.32 147.6 l 100.32 118.8 l 39.12 118.8 l 39.12 147.6 l 39.6 119.28 l 99.84 119.28 l 99.84 147.12 l 39.6 147.12 l 39.6 119.28 l 39.12 147.6 l h f* BT 41.28 140.4 TD /F1 6.96 Tf 0.0175 Tc 0.8825 Tw (Date of Birth/Age) Tj ET 99.84 147.6 m 134.16 147.6 l 134.16 118.8 l 99.84 118.8 l 99.84 147.6 l 100.32 119.28 l 133.68 119.28 l 133.68 147.12 l 100.32 147.12 l 100.32 119.28 l 99.84 147.6 l h f* BT 102.24 139.2 TD -0.2 Tc 0 Tw (Sex) Tj 0 -10.56 TD 0.1638 Tc -0.1038 Tw (__M __ F) Tj ET 133.68 147.6 m 295.68 147.6 l 295.68 118.8 l 133.68 118.8 l 133.68 147.6 l 134.16 119.28 l 295.2 119.28 l 295.2 147.12 l 134.16 147.12 l 134.16 119.28 l 133.68 147.6 l h f* BT 135.84 140.4 TD 0.3432 Tc 0.7168 Tw (Full Name of Non-Motorist \(Last, First, Middle\)) Tj ET 295.2 147.6 m 575.52 147.6 l 575.52 118.8 l 295.2 118.8 l 295.2 147.6 l 295.68 119.28 l 575.04 119.28 l 575.04 147.12 l 295.68 147.12 l 295.68 119.28 l 295.2 147.6 l h f* BT 297.36 140.4 TD 0.135 Tc 1.005 Tw (Street Address) Tj 144 0 TD 0.1684 Tc 0 Tw (City/Town) Tj 72 0 TD 0.096 Tc (State) Tj 36 0 TD 0.1375 Tc (Zip) Tj ET 39.12 762.48 m 575.52 762.48 l 575.52 744.96 l 39.12 744.96 l 39.12 762.48 l 39.6 745.44 l 575.04 745.44 l 575.04 762 l 39.6 762 l 39.6 745.44 l 39.12 762.48 l h f* BT 41.28 755.04 TD -0.0142 Tc 0.7594 Tw (Please provide the full name, address, and DOB or Age for all passengers in your vehicle. Then write the corresponding code in each of the boxes for each occupant of the vehicle) Tj 0 -6.96 TD -0.0047 Tc 0.918 Tw (\(yourself and all passengers\). A list of the possible codes is provided at the bottom of this section.) Tj ET 39.12 511.44 m 125.04 511.44 l 125.04 457.44 l 39.12 457.44 l 39.12 511.44 l 39.6 457.92 l 124.56 457.92 l 124.56 510.96 l 39.6 510.96 l 39.6 457.92 l 39.12 511.44 l h f* 124.56 511.44 m 245.52 511.44 l 245.52 457.44 l 124.56 457.44 l 124.56 511.44 l 125.04 457.92 l 245.04 457.92 l 245.04 510.96 l 125.04 510.96 l 125.04 457.92 l 124.56 511.44 l h f* 245.28 511.44 m 406.08 511.44 l 406.08 457.44 l 245.28 457.44 l 245.28 511.44 l 245.76 457.92 l 405.6 457.92 l 405.6 510.96 l 245.76 510.96 l 245.76 457.92 l 245.28 511.44 l h f* 405.6 511.44 m 575.52 511.44 l 575.52 457.44 l 405.6 457.44 l 405.6 511.44 l 406.08 457.92 l 575.04 457.92 l 575.04 510.96 l 406.08 510.96 l 406.08 457.92 l 405.6 511.44 l h f* 89.04 286.56 m 416.16 286.56 l 416.16 239.76 l 89.04 239.76 l 89.04 286.56 l 89.76 240.24 l 415.68 240.24 l 415.68 285.84 l 89.76 285.84 l 89.76 240.24 l 89.04 286.56 l h f* 39.12 225.84 m 575.52 225.84 l 575.52 211.44 l 39.12 211.44 l 39.12 225.84 l 39.6 211.92 l 575.04 211.92 l 575.04 225.36 l 39.6 225.36 l 39.6 211.92 l 39.12 225.84 l h f* BT 41.28 215.76 TD /F0 6.96 Tf 0.0434 Tc 0.3286 Tw (Indicate the type of non-motorist involved) Tj 213.84 0.72 TD /F1 6.96 Tf -0.0287 Tc 0.9287 Tw (1 Pedestrian) Tj 65.28 0 TD -0.0806 Tc 0.9806 Tw (2 Cyclist) Tj 54 0 TD -0.0547 Tc 0.3547 Tw (3 Skater) Tj 52.8 0 TD -0.0697 Tc 0.8497 Tw (97 Other) Tj 55.2 0 TD 0.0433 Tc 0.8567 Tw (99 Unknown) Tj ET 39.12 211.92 m 304.08 211.92 l 304.08 147.12 l 39.12 147.12 l 39.12 211.92 l 39.6 147.6 l 303.6 147.6 l 303.6 211.44 l 39.6 211.44 l 39.6 147.6 l 39.12 211.92 l h f* BT 41.28 204.24 TD /F0 7.44 Tf -0.0417 Tc 1.2417 Tw (What was the non-motorist doing prior to the crash?) Tj 0 -10.08 TD /F1 7.44 Tf 0.12 Tc 0 Tw (1) Tj 9.12 0 TD 0.0481 Tc 0.5719 Tw (Entering or crossing location) Tj 126 0 TD 0.12 Tc 0 Tw (6) Tj 11.28 0 TD 0.019 Tc 0.641 Tw (Working on vehicle) Tj -146.4 -8.88 TD 0.12 Tc 0 Tw (2) Tj 9.12 0 TD 0.0404 Tc 0.8996 Tw (Walking, running, or cycling) Tj 126 0 TD 0.12 Tc 0 Tw (7) Tj 11.28 0 TD 0.2029 Tc (Standing) Tj -146.4 -9.12 TD 0.12 Tc (3) Tj 9.12 0 TD 0.1301 Tc (Working) Tj 126 0 TD -0.12 Tc (97) Tj 11.28 0 TD -0.0282 Tc (Other) Tj -146.4 -8.88 TD 0.12 Tc (4) Tj 9.12 0 TD 0.0782 Tc 0.9418 Tw (Pushing vehicle) Tj 126 0 TD -0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.0938 Tc (Unknown) Tj -146.4 -9.12 TD 0.12 Tc (5) Tj 9.12 0 TD 0.0581 Tc 0.0819 Tw (Approaching or leaving vehicle) Tj ET 303.6 211.92 m 575.52 211.92 l 575.52 147.12 l 303.6 147.12 l 303.6 211.92 l 304.08 147.6 l 575.04 147.6 l 575.04 211.44 l 304.08 211.44 l 304.08 147.6 l 303.6 211.92 l h f* 248.16 119.28 m 408.96 119.28 l 408.96 58.08 l 248.16 58.08 l 248.16 119.28 l 248.64 58.56 l 408.48 58.56 l 408.48 118.8 l 248.64 118.8 l 248.64 58.56 l 248.16 119.28 l h f* 408.48 119.28 m 575.52 119.28 l 575.52 79.68 l 408.48 79.68 l 408.48 119.28 l 408.96 80.16 l 575.04 80.16 l 575.04 118.8 l 408.96 118.8 l 408.96 80.16 l 408.48 119.28 l h f* 39.12 119.28 m 248.64 119.28 l 248.64 58.08 l 39.12 58.08 l 39.12 119.28 l 39.6 58.56 l 248.16 58.56 l 248.16 118.8 l 39.6 118.8 l 39.6 58.56 l 39.12 119.28 l h f* BT 41.52 110.64 TD /F0 7.44 Tf 0.1456 Tc 1.1144 Tw (Safety Equipment?) Tj 0 -9.6 TD /F1 7.44 Tf 0.12 Tc 0 Tw (0) Tj 8.88 0 TD 0.0009 Tc 0.5391 Tw (None used) Tj 123.84 0 TD 0.12 Tc 0 Tw (9) Tj 11.28 0 TD 0.2162 Tc (Lighting) Tj -144 -9.36 TD 0.12 Tc (6) Tj 8.88 0 TD 0.1494 Tc (Helmet) Tj 123.84 0 TD -0.12 Tc (10) Tj 11.28 0 TD -0.0282 Tc (Other) Tj -144 -9.6 TD 0.12 Tc (7) Tj 8.88 0 TD 0.0656 Tc 0.4744 Tw (Protective pads \(elbows, knees, etc.\)) Tj 123.84 0 TD -0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.0938 Tc (Unknown) Tj -144 -9.36 TD 0.12 Tc (8) Tj 8.88 0 TD 0.0796 Tc -0.4996 Tw (Reflective clothing) Tj ET 408.48 80.16 m 575.52 80.16 l 575.52 57.84 l 408.48 57.84 l 408.48 80.16 l 408.96 58.32 l 575.04 58.32 l 575.04 79.44 l 408.96 79.44 l 408.96 58.32 l 408.48 80.16 l h f* BT 412.8 72.48 TD /F0 6.48 Tf -0.0577 Tc 0.9337 Tw (If transported, please indicate Hospital/Medical Facility:) Tj ET 39.12 444 m 180.48 444 l 180.48 429.6 l 39.12 429.6 l 39.12 444 l 39.6 430.08 l 180 430.08 l 180 443.52 l 39.6 443.52 l 39.6 430.08 l 39.12 444 l h f* BT 41.52 434.88 TD /F0 6.96 Tf 0.0419 Tc 0.2821 Tw (Number of occupants in the ) Tj -0.9451 Tc 0 Tw (V) Tj 0.1593 Tc 0.0207 Tw (ehicle: _____) Tj ET 485.52 444 m 575.52 444 l 575.52 429.6 l 485.52 429.6 l 485.52 444 l 486 430.08 l 575.04 430.08 l 575.04 443.52 l 486 443.52 l 486 430.08 l 485.52 444 l h f* BT 486.72 435.12 TD 0.0727 Tc -0.0727 Tw ( Hit and Run? __Yes __No) Tj -306.48 12.24 TD 1 1 1 rg /F0 12 Tf -0.018 Tc 0.058 Tw (Section D: Other ) Tj -1.224 Tc 0 Tw (V) Tj -0.0356 Tc 0.0956 Tw (ehicle\(s\) Involved in the Crash) Tj 117.12 -420.48 TD 0 0 0 rg /F1 6 Tf -0.1008 Tc -0.1992 Tw (Page 3) Tj 1 1 1 rg ET 273.6 429.84 m 309.12 429.84 l 309.12 408.72 l 273.6 408.72 l 273.6 429.84 l h f* 0 0 0 rg 273.36 430.08 m 309.36 430.08 l 309.36 408.48 l 273.36 408.48 l 273.36 430.08 l 273.84 408.96 l 308.88 408.96 l 308.88 429.6 l 273.84 429.6 l 273.84 408.96 l 273.36 430.08 l h f* 1 1 1 rg 309.36 429.84 m 387.84 429.84 l 387.84 408.72 l 309.36 408.72 l 309.36 429.84 l h f* 0 0 0 rg 309.12 430.08 m 388.08 430.08 l 388.08 408.48 l 309.12 408.48 l 309.12 430.08 l 309.6 408.96 l 387.6 408.96 l 387.6 429.6 l 309.6 429.6 l 309.6 408.96 l 309.12 430.08 l h f* 1 1 1 rg 387.84 429.84 m 575.28 429.84 l 575.28 408.72 l 387.84 408.72 l 387.84 429.84 l h f* 0 0 0 rg 387.6 430.08 m 575.52 430.08 l 575.52 408.48 l 387.6 408.48 l 387.6 430.08 l 388.08 408.96 l 575.04 408.96 l 575.04 429.6 l 388.08 429.6 l 388.08 408.96 l 387.6 430.08 l h f* BT 277.44 415.68 TD 0.155 Tc -0.055 Tw (__ M __ F) Tj ET 412.56 444 m 486 444 l 486 429.6 l 412.56 429.6 l 412.56 444 l 413.04 430.08 l 485.28 430.08 l 485.28 443.52 l 413.04 443.52 l 413.04 430.08 l 412.56 444 l h f* BT 413.76 435.12 TD /F0 6.96 Tf 0.0795 Tc -0.2195 Tw ( Moped? __Yes __No) Tj ET 180 444 m 302.16 444 l 302.16 429.6 l 180 429.6 l 180 444 l 180.48 430.08 l 301.44 430.08 l 301.44 443.52 l 180.48 443.52 l 180.48 430.08 l 180 444 l h f* BT 182.4 434.88 TD 0.0615 Tc 0.5385 Tw (Number of injured occupants: _____) Tj ET 415.68 286.56 m 575.52 286.56 l 575.52 239.76 l 415.68 239.76 l 415.68 286.56 l 416.4 240.24 l 575.04 240.24 l 575.04 286.08 l 416.4 286.08 l 416.4 240.24 l 415.68 286.56 l h f* BT 418.08 279.6 TD -0.9451 Tc 0 Tw (V) Tj 0.0895 Tc -0.0295 Tw (ehicle Damaged Area) Tj 68.64 0 TD /F1 6.96 Tf 0.0246 Tc 0.5154 Tw ( \(circle up to three\)) Tj 31.92 -9.12 TD -0.0631 Tc 0.4831 Tw (0 None) Tj 0 -6.96 TD 0.0024 Tc 1.1376 Tw (10 Undercarriage) Tj T* -0.0425 Tc 0.7025 Tw (11 Totaled) Tj 0 -7.2 TD 0.0332 Tc 0.8668 Tw (97 Other) Tj 0 -6.96 TD 0.0433 Tc 1.0967 Tw (99 Unknown) Tj ET 450.72 248.88 m 456.96 255.36 l 457.2 255.12 l 450.96 248.4 l 450.72 248.88 l h f* 465.12 255.84 m 472.32 248.88 l 471.84 248.4 l 464.88 255.6 l 465.12 255.84 l h f* 464.64 261.12 m 471.84 269.52 l 472.32 269.28 l 464.88 260.88 l 464.64 261.12 l h f* 450.96 269.52 m 457.92 261.12 l 457.44 260.64 l 450.48 269.04 l 450.96 269.52 l h f* 461.28 247.68 m 461.28 270.24 l 462 270.24 l 462 247.68 l 461.28 247.68 l h f* 434.16 267.6 m 437.04 269.76 l 440.64 270.24 l 474.48 270.24 l 477.84 269.76 l 480.72 267.6 l 482.88 264.72 l 483.36 261.36 l 483.36 256.56 l 482.88 253.2 l 480.72 250.32 l 477.84 248.4 l 474.48 247.68 l 440.64 247.68 l 437.04 248.4 l 434.16 250.32 l 432.24 253.2 l 431.52 256.56 l 431.52 261.36 l 432.24 264.72 l 434.16 267.6 l 434.64 267.36 l 432.72 264.72 l 432 261.36 l 432 256.56 l 432.72 253.44 l 434.64 250.56 l 437.28 248.88 l 440.64 248.16 l 474.48 248.16 l 477.6 248.88 l 480.48 250.56 l 482.4 253.44 l 482.88 256.56 l 482.88 261.36 l 482.4 264.72 l 480.48 267.36 l 477.6 269.28 l 474.48 269.76 l 440.64 269.76 l 437.28 269.28 l 434.64 267.36 l 434.16 267.6 l h f* 450.96 269.04 m 452.4 270 l 454.08 270.24 l 468.72 270.24 l 470.4 270 l 471.84 269.04 l 472.8 267.6 l 473.04 265.92 l 473.04 252.24 l 472.8 250.32 l 471.84 248.88 l 470.4 247.92 l 468.72 247.68 l 454.08 247.68 l 452.4 247.92 l 450.96 248.88 l 450 250.32 l 449.76 252.24 l 449.76 265.92 l 450 267.6 l 450.96 269.04 l 451.2 268.56 l 450.48 267.36 l 450.24 265.92 l 450.24 252.24 l 450.48 250.56 l 451.2 249.36 l 452.64 248.4 l 454.08 248.16 l 468.72 248.16 l 470.16 248.4 l 471.36 249.36 l 472.32 250.56 l 472.56 252.24 l 472.56 265.92 l 472.32 267.36 l 471.36 268.56 l 470.16 269.52 l 468.72 269.76 l 454.08 269.76 l 452.64 269.52 l 451.2 268.56 l 450.96 269.04 l h f* 1 1 1 rg 457.44 261.6 m 465.6 261.6 l 465.6 255.36 l 457.44 255.36 l 457.44 261.6 l h f* 0 0 0 rg 457.2 261.84 m 465.84 261.84 l 465.84 254.88 l 457.2 254.88 l 457.2 261.84 l 457.68 255.6 l 465.36 255.6 l 465.36 261.36 l 457.68 261.36 l 457.68 255.6 l 457.2 261.84 l h f* 436.32 258 m 444.72 258 l 444.72 257.28 l 436.32 257.28 l 436.32 258 l h f* 438.96 256.32 m 435.12 258 l 438.96 259.68 l 438.96 256.32 l h f* 438.72 256.08 m 435.12 257.76 l 434.64 258 l 435.12 258.24 l 435.12 258 l 435.36 258.24 l 438.96 256.56 l 438.96 256.32 l 438.72 256.08 l h f* 435.12 258.24 m 438.72 259.92 l 439.2 259.92 l 439.2 259.68 l 438.96 259.68 l 438.96 259.44 l 435.36 257.76 l 435.12 258 l 435.12 258.24 l h f* 439.2 259.68 m 439.2 255.84 l 438.72 256.08 l 438.96 256.32 l 438.72 256.32 l 438.72 259.68 l 439.2 259.68 l h f* BT 426 256.32 TD 0.12 Tc 0 Tw (1) Tj 33.84 0 TD (9) Tj 27.36 0 TD (5) Tj -61.2 -14.88 TD (8) Tj 33.84 0 TD (7) Tj 27.36 0 TD (6) Tj -61.2 30.48 TD (2) Tj 33.84 0 TD (3) Tj 27.36 0 TD (4) Tj -83.28 320.16 TD /F0 7.44 Tf 0.1042 Tc (C.) Tj 9.12 0 TD -0.0824 Tc 1.1024 Tw (Air Bag Status) Tj -9.12 -10.08 TD /F1 7.44 Tf 0.12 Tc 0 Tw (1) Tj 11.28 0 TD -0.0363 Tc (Deployed-front) Tj -11.28 -10.08 TD 0.12 Tc (2) Tj 11.28 0 TD -0.0331 Tc (Deployed-side) Tj -11.28 -9.84 TD 0.12 Tc (3) Tj 11.28 0 TD 0.0071 Tc -0.4271 Tw (Deployed both) Tj 0 -10.08 TD -0.0607 Tc 0 Tw (front) Tj 16.32 0 TD 0.0787 Tc -0.4987 Tw (and side) Tj -27.6 -10.08 TD 0.12 Tc 0 Tw (4) Tj 11.28 0 TD 0.0186 Tc -0.4386 Tw (Not deployed) Tj -11.28 -9.84 TD 0.12 Tc 0 Tw (5) Tj 11.28 0 TD -0.0168 Tc -0.4032 Tw (Not applicable) Tj -11.28 -10.08 TD -0.6 Tc 0 Tw (99) Tj 11.28 0 TD -0.0776 Tc (Unknown) Tj 53.52 70.08 TD /F0 7.44 Tf 0.1042 Tc (D.) Tj 11.28 0 TD -0.02 Tc 0.8 Tw (Air Bag Switch) Tj -11.28 -10.08 TD /F1 7.44 Tf 0.12 Tc 0 Tw (1) Tj 11.28 0 TD -0.0122 Tc -0.3278 Tw (Switch in ON position) Tj -11.28 -10.08 TD 0.12 Tc 0 Tw (2) Tj 11.28 0 TD -0.0253 Tc -0.3947 Tw (Switch in OFF position) Tj -11.28 -9.84 TD 0.12 Tc 0 Tw (3) Tj 11.28 0 TD -0 Tc 0.4603 Tw (ON-OFF switch not present) Tj -11.28 -10.08 TD 0.12 Tc 0 Tw (4) Tj 11.28 0 TD -0.0135 Tc 0.1335 Tw (Unknown if switch is present) Tj -11.28 -10.08 TD -0.6 Tc 0 Tw (99) Tj 11.28 0 TD -0.0776 Tc (Unknown) Tj -438.48 -38.4 TD /F0 6.96 Tf -0.3112 Tc (E.) Tj 11.28 0 TD -0.0881 Tc -0.4519 Tw (Ejected From Vehicle?) Tj -11.28 -8.88 TD /F1 6.96 Tf 0.12 Tc 0 Tw (0) Tj 11.28 0 TD 0.1529 Tc 0.7471 Tw (Not ejected) Tj -11.28 -8.64 TD 0.12 Tc 0 Tw (1) Tj 11.28 0 TD -0.0156 Tc 0.9156 Tw (Totally ejected) Tj -11.28 -8.64 TD 0.12 Tc 0 Tw (2) Tj 11.28 0 TD 0.0089 Tc 0.6511 Tw (Partially ejected) Tj -11.28 -8.64 TD 0.12 Tc 0 Tw (3) Tj 11.28 0 TD -0.0127 Tc 0.4327 Tw (Not applicable) Tj -11.28 -8.88 TD 0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.1243 Tc (Unknown) Tj 74.16 43.44 TD /F0 6.96 Tf -0.3563 Tc (F.) Tj 11.28 0 TD -0.194 Tc (Trapped?) Tj -11.28 -9.12 TD /F1 6.96 Tf 0.12 Tc (0) Tj 11.28 0 TD 0.1087 Tc 0.7913 Tw (Not trapped) Tj -11.28 -8.88 TD 0.12 Tc 0 Tw (1) Tj 11.28 0 TD 0.0088 Tc 0.9712 Tw (Freed by mechanical means) Tj -11.28 -9.12 TD 0.12 Tc 0 Tw (2) Tj 11.28 0 TD 0.0429 Tc 0.9371 Tw (Freed by non-mechanical means) Tj -11.28 -8.88 TD 0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.1243 Tc (Unknown) Tj 109.44 37.2 TD /F0 6.96 Tf -1.0574 Tc (G.) Tj 11.28 0 TD 0.1031 Tc (Injured?) Tj -11.28 -8.64 TD /F1 6.96 Tf 0.12 Tc (1) Tj 11.28 0 TD -0.0061 Tc 0.4261 Tw (Fatal injury) Tj -11.28 -7.92 TD -0.0065 Tc 1.1465 Tw (Non-fatal injury) Tj ET 247.68 486.96 45.6 0.24 re f BT 293.28 487.92 TD -0.0149 Tc 0 Tw (:) Tj -45.6 -9.36 TD 0.12 Tc (2) Tj 11.28 0 TD -0.0446 Tc 0.036 Tw (Incapacitating 5) Tj 96.72 0 TD 0.0684 Tc 0.9516 Tw ( No injury) Tj -108 -9.36 TD 0.12 Tc 0 Tw (3) Tj 11.28 0 TD 0.2895 Tc (Non-incapacitating) Tj 78.72 0 TD -0.12 Tc 0.24 Tw ( 99) Tj 18 0 TD 0.4328 Tc 0 Tw (Unknown) Tj -108 -9.36 TD 0.12 Tc (4) Tj 11.28 0 TD 0.0394 Tc (Possible) Tj 149.04 43.44 TD /F0 6.96 Tf -0.0974 Tc (H.) Tj 11.28 0 TD 0.0011 Tc 0.5989 Tw (Transported for Medical Care?) Tj -11.28 -9.12 TD /F1 6.96 Tf 0.12 Tc 0 Tw (1) Tj 8.88 0 TD 0.1548 Tc 0.7452 Tw (Not transported) Tj 94.56 0 TD 0.12 Tc 0 Tw (97) Tj 11.28 0 TD 0.2384 Tc (Other) Tj -114.72 -8.88 TD 0.12 Tc (2) Tj 8.88 0 TD 0.0767 Tc 0.9433 Tw (EMS \(emergency service\)) Tj 94.56 0 TD 0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.1243 Tc (Unknown) Tj -114.72 -9.12 TD 0.12 Tc (3) Tj 8.88 0 TD -0.02 Tc (Police) Tj -26.88 -51.84 TD -0.2822 Tc 1.0222 Tw (Commercial Driver\222s License Endorsements) Tj 0 -6 TD -0.3188 Tc 0.4988 Tw (H __ Hazardous) Tj 72 0 TD -0.2971 Tc 0.4771 Tw (N __ Tank vehicles) Tj 72 0 TD -0.1219 Tc 0 Tw (P__Passenger) Tj -144 -6.24 TD -0.2479 Tc 0.4279 Tw (T __ Doubles/Triples) Tj 72 0 TD -0.3463 Tc 0.6703 Tw (X __ Tank and Hazardous) Tj 72 0 TD 0 Tc 1.02 Tw ( ) Tj 11.04 0 TD -0.3759 Tc 0.7959 Tw ( transport) Tj -503.52 -54.72 TD /F0 6.96 Tf 0.1007 Tc 0.8793 Tw (Indicate type of vehicle) Tj 0 -18.48 TD /F1 6.96 Tf 0 Tc -0.06 Tw ( ) Tj 2.4 1.44 TD 0.0022 Tc 1.0578 Tw (1 Passenger car) Tj 105.6 0 TD -0.0332 Tc 1.0132 Tw (4 Bus \(15 or more passengers\)) Tj 121.44 0 TD -0.0011 Tc 0.7811 Tw (8 Truck/trailer) Tj 92.16 0 TD 0.0719 Tc 0.8281 Tw (12 Tractor/triples) Tj 110.4 0 TD 0.0332 Tc 0.6268 Tw (97 Other) Tj -432 -9.12 TD -0.0258 Tc 0.8458 Tw ( 2 Light truck \(van, mini-van,) Tj 108 0 TD 0.0153 Tc 0.9447 Tw (5 Bus \(7-15 passengers\)) Tj 121.44 0 TD -0.0035 Tc 0.9035 Tw (9 Truck tractor \(bobtail\)) Tj 92.16 0 TD 0.0098 Tc 0.9502 Tw (13 Unknown heavy truck) Tj 110.4 0 TD 0.0166 Tc 0.8834 Tw (99 Unknown) Tj -432 -9.36 TD -0.0207 Tc 0.6464 Tw ( pick-up, sport utility\)) Tj 108 0 TD -0.0039 Tc 0.7119 Tw (6 Single-unit truck \(2 axles\)) Tj 121.44 0 TD 0.0753 Tc 0.8247 Tw (10 Tractor/semi-trailer) Tj 92.16 0 TD -0.0049 Tc 0.9049 Tw (14 Motor home/recreational vehicle) Tj -321.6 -9.12 TD -0.026 Tc 0.846 Tw ( 3 Motorcycle) Tj 108 0 TD -0.0167 Tc 0.7967 Tw (7 Single-unit truck \(3 or more axles\)) Tj 121.44 0 TD 0.0758 Tc 0.7042 Tw (11 Tractor/doubles) Tj -179.52 -34.8 TD /F0 6.96 Tf 0.0396 Tc 0.8604 Tw (What Was the Vehicle Doing Prior to the Crash?) Tj 0 -10.56 TD /F1 6.96 Tf 0 Tc -0.06 Tw ( ) Tj 2.16 -3.6 TD -0.0294 Tc 0.8094 Tw (1 Travelling straight ahead) Tj 87.84 0 TD -0.0319 Tc 0.7719 Tw (4 Turning left) Tj 72 0 TD -0.0467 Tc 0.7667 Tw (7 Leaving traffic lane) Tj 72 0 TD -0.0442 Tc 0.8242 Tw (10 Backing) Tj 45.12 0 TD 0.0332 Tc 0.6268 Tw (97 Other) Tj -279.12 -10.56 TD -0.0221 Tc 0.7621 Tw ( 2 Slowing or stopped) Tj 90 0 TD -0.0493 Tc 0.7893 Tw (5 Changing lanes) Tj 72 0 TD -0.0191 Tc 0.5991 Tw (8 Making U-turn) Tj 72 0 TD -0.016 Tc 0.796 Tw (11 Parked) Tj 45.12 0 TD 0.0166 Tc 0.8834 Tw (99 Unknown) Tj -279.12 -10.32 TD -0.0133 Tc 0.6733 Tw ( 3 Turning right) Tj 90 0 TD -0.0424 Tc 0.8224 Tw (6 Entering traffic lane) Tj 72 0 TD 0.0627 Tc 0.8373 Tw (9 Overtaking/passing) Tj 22.32 180 TD 0.2 Tc 0 Tw (Sex) Tj 35.76 1.44 TD 0.3393 Tc 1.0407 Tw (License Class) Tj 0 -5.28 TD 0.4488 Tc -0.1008 Tw (__ D __ A __ B __C) Tj 0 -7.44 TD 0.36 Tc 0 Tw (__) Tj 7.92 0 TD 0.3322 Tc 0.8078 Tw ( M __ Unknown) Tj -13.68 -207.36 TD /F0 6.96 Tf 0.07 Tc 0.8643 Tw (Where was the non-motorist prior to the crash?) Tj 0 -9.6 TD /F1 6.96 Tf 0.12 Tc 0 Tw (1) Tj 9.12 0 TD 0.0628 Tc 0.9972 Tw (Marked crosswalk at intersection) Tj 126 0 TD 0.12 Tc 0 Tw (6) Tj 11.28 0 TD 0.0109 Tc 0.7091 Tw (Median \(but not on shoulder\)) Tj -146.4 -8.88 TD 0.12 Tc 0 Tw (2) Tj 9.12 0 TD 0.0485 Tc 0.9115 Tw (At intersection but no crosswalk) Tj 126 0 TD 0.12 Tc 0 Tw (7) Tj 11.28 0 TD 0.125 Tc (Island) Tj -146.4 -9.12 TD 0.12 Tc (3) Tj 9.12 0 TD 0.126 Tc 1.014 Tw (Non-intersection crosswalk) Tj 126 0 TD 0.12 Tc 0 Tw (8) Tj 11.28 0 TD 0.0984 Tc (Shoulder) Tj -146.4 -8.88 TD 0.12 Tc (4) Tj 9.12 0 TD 0.1332 Tc 1.2468 Tw (In roadway) Tj 126 0 TD 0.12 Tc 0 Tw (9) Tj 11.28 0 TD 0.0019 Tc (Sidewalk) Tj -146.4 -9.12 TD 0.12 Tc (5) Tj 9.12 0 TD 0.0618 Tc 0.7182 Tw (Not in roadway) Tj 126 0 TD 0.12 Tc 0 Tw (10) Tj 11.28 0 TD 0.0334 Tc 0.8666 Tw (Shared-use path or trails) Tj -11.28 -8.88 TD 0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.1243 Tc (Unknown) Tj -201.6 -38.64 TD /F0 7.44 Tf 0.0565 Tc (Injured?) Tj 0 -9.84 TD /F1 7.44 Tf 0.12 Tc (1) Tj 11.04 0 TD -0.0449 Tc -0.3751 Tw (Fatal injury) Tj -11.04 -8.88 TD -0.0616 Tc -0.3584 Tw (Non-fatal injury) Tj ET 250.56 91.2 46.8 0.48 re f BT 297.36 92.4 TD 0.0917 Tc 0 Tw (:) Tj -46.8 -10.08 TD 0.12 Tc (2) Tj 11.04 0 TD -0.0105 Tc (Incapacitating) Tj 78.96 0 TD 0.12 Tc (5) Tj 11.04 0 TD -0.0882 Tc -0.3318 Tw (No injury) Tj -101.04 -10.32 TD 0.12 Tc 0 Tw (3) Tj 11.04 0 TD -0.0349 Tc (Non-incapacitating) Tj 78.96 0 TD -0.6 Tc (99) Tj 11.04 0 TD -0.0776 Tc (Unknown) Tj -101.04 -10.08 TD 0.12 Tc (4) Tj 11.04 0 TD -0.0406 Tc (Possible) Tj 149.28 48.96 TD /F0 6.96 Tf 0.0011 Tc 0.5989 Tw (Transported for Medical Care?) Tj 0 -8.88 TD /F1 6.96 Tf 0.12 Tc 0 Tw (1) Tj 8.88 0 TD 0.1548 Tc 0.7452 Tw (Not transported) Tj 94.56 0 TD 0.12 Tc 0 Tw (97) Tj 11.28 0 TD 0.2384 Tc (Other) Tj -114.72 -9.12 TD 0.12 Tc (2) Tj 8.88 0 TD 0.0767 Tc 0.9433 Tw (EMS \(emergency service\)) Tj 94.56 0 TD 0.12 Tc 0 Tw (99) Tj 11.28 0 TD 0.1243 Tc (Unknown) Tj -114.72 -8.88 TD 0.12 Tc (3) Tj 8.88 0 TD -0.02 Tc (Police) Tj -117.12 353.28 TD /F0 6.96 Tf -0.96 Tc (W) Tj 0.0309 Tc 0.1491 Tw (as Vehicle Damage ) Tj 65.04 0 TD /F1 6.96 Tf 0 Tc -0.06 Tw ( ) Tj 1.92 -3.36 TD 0.0712 Tc 0.4688 Tw (__Yes ___No) Tj -66.96 -2.64 TD /F0 6.96 Tf 0.12 Tc 0.54 Tw (above $1000?) Tj ET endstream endobj 45 0 obj 43444 endobj 43 0 obj << /Type /Page /Parent 5 0 R /Resources << /Font << /F0 6 0 R /F1 8 0 R >> /ProcSet 2 0 R >> /Contents 44 0 R >> endobj 47 0 obj << /Length 48 0 R >> stream 0.24 w 1 J 1 j 0.498 0.498 0.498 RG 46.08 550.8 m 457.2 550.8 l S 46.08 456.72 m 457.2 456.72 l S 46.08 532.08 m 457.2 532.08 l S 46.08 513.12 m 457.2 513.12 l S 46.08 494.4 m 457.2 494.4 l S 46.08 475.44 m 457.2 475.44 l S 46.08 569.76 m 457.2 569.76 l S 46.08 437.76 m 457.2 437.76 l S 86.64 423.12 m 86.64 583.44 l S 114 423.12 m 114 583.44 l S 141.36 423.12 m 141.36 583.44 l S 168.72 423.12 m 168.72 583.44 l S 196.08 423.12 m 196.08 583.44 l S 59.28 423.12 m 59.28 583.44 l S 223.44 423.12 m 223.44 583.44 l S 250.8 423.12 m 250.8 583.44 l S 278.16 423.12 m 278.16 583.44 l S 305.28 423.12 m 305.28 583.44 l S 332.64 423.12 m 332.64 583.44 l S 360 423.12 m 360 583.44 l S 387.36 423.12 m 387.36 583.44 l S 414.72 423.12 m 414.72 583.44 l S 442.08 423.12 m 442.08 583.44 l S 0 0 0 rg 46.08 255.84 m 563.76 255.84 l 563.76 255.36 l 46.08 255.36 l 46.08 255.84 l h f* 46.08 237.84 m 563.76 237.84 l 563.76 237.36 l 46.08 237.36 l 46.08 237.84 l h f* 46.08 219.84 m 563.76 219.84 l 563.76 219.36 l 46.08 219.36 l 46.08 219.84 l h f* 46.08 201.84 m 563.76 201.84 l 563.76 201.36 l 46.08 201.36 l 46.08 201.84 l h f* 46.08 183.84 m 563.76 183.84 l 563.76 183.36 l 46.08 183.36 l 46.08 183.84 l h f* 46.08 165.6 m 563.76 165.6 l 563.76 165.12 l 46.08 165.12 l 46.08 165.6 l h f* 46.08 147.6 m 563.76 147.6 l 563.76 147.12 l 46.08 147.12 l 46.08 147.6 l h f* 46.08 129.6 m 563.76 129.6 l 563.76 129.12 l 46.08 129.12 l 46.08 129.6 l h f* 46.32 774 m 563.52 774 l 563.52 758.16 l 46.32 758.16 l 46.32 774 l h f* q 46.08 757.68 517.92 16.32 re h W n 46.08 774.24 m 563.76 774.24 l 563.76 757.92 l 46.08 757.92 l 46.08 774.24 l 46.56 758.4 l 563.28 758.4 l 563.28 773.76 l 46.56 773.76 l 46.56 758.4 l 46.08 774.24 l h f* Q BT 238.08 761.76 TD 1 1 1 rg /F0 11.04 Tf -0.1236 Tc 1.1236 Tw (Section F: Crash Conditions) Tj 0 0 0 rg ET 46.08 757.92 m 135.12 757.92 l 135.12 654.72 l 46.08 654.72 l 46.08 757.92 l 46.56 655.2 l 134.64 655.2 l 134.64 757.44 l 46.56 757.44 l 46.56 655.2 l 46.08 757.92 l h f* 134.64 757.92 m 230.16 757.92 l 230.16 654.72 l 134.64 654.72 l 134.64 757.92 l 135.12 655.2 l 229.68 655.2 l 229.68 757.44 l 135.12 757.44 l 135.12 655.2 l 134.64 757.92 l h f* 229.92 757.92 m 335.52 757.92 l 335.52 654.72 l 229.92 654.72 l 229.92 757.92 l 230.4 655.2 l 335.04 655.2 l 335.04 757.44 l 230.4 757.44 l 230.4 655.2 l 229.92 757.92 l h f* 335.04 757.92 m 389.52 757.92 l 389.52 654.72 l 335.04 654.72 l 335.04 757.92 l 335.52 655.2 l 389.04 655.2 l 389.04 757.44 l 335.52 757.44 l 335.52 655.2 l 335.04 757.92 l h f* 389.04 757.92 m 480.48 757.92 l 480.48 654.72 l 389.04 654.72 l 389.04 757.92 l 389.52 655.2 l 480 655.2 l 480 757.44 l 389.52 757.44 l 389.52 655.2 l 389.04 757.92 l h f* 480 757.92 m 563.76 757.92 l 563.76 598.32 l 480 598.32 l 480 757.92 l 480.48 598.8 l 563.28 598.8 l 563.28 757.44 l 480.48 757.44 l 480.48 598.8 l 480 757.92 l h f* 302.4 655.2 m 480.48 655.2 l 480.48 598.32 l 302.4 598.32 l 302.4 655.2 l 302.88 598.8 l 480 598.8 l 480 654.72 l 302.88 654.72 l 302.88 598.8 l 302.4 655.2 l h f* 244.56 655.2 m 302.88 655.2 l 302.88 598.32 l 244.56 598.32 l 244.56 655.2 l 245.04 598.8 l 302.4 598.8 l 302.4 654.72 l 245.04 654.72 l 245.04 598.8 l 244.56 655.2 l h f* 188.16 655.2 m 245.04 655.2 l 245.04 598.32 l 188.16 598.32 l 188.16 655.2 l 188.64 598.8 l 244.56 598.8 l 244.56 654.72 l 188.64 654.72 l 188.64 598.8 l 188.16 655.2 l h f* 46.08 655.2 m 188.64 655.2 l 188.64 598.32 l 46.08 598.32 l 46.08 655.2 l 46.56 598.8 l 188.16 598.8 l 188.16 654.72 l 46.56 654.72 l 46.56 598.8 l 46.08 655.2 l h f* 46.32 598.56 m 563.52 598.56 l 563.52 582.72 l 46.32 582.72 l 46.32 598.56 l h f* 46.08 598.8 m 563.76 598.8 l 563.76 582.48 l 46.08 582.48 l 46.08 598.8 l 46.56 582.96 l 563.28 582.96 l 563.28 598.32 l 46.56 598.32 l 46.56 582.96 l 46.08 598.8 l h f* BT 242.16 586.32 TD 1 1 1 rg -0.0921 Tc 0.8521 Tw (Section G: Crash Diagram) Tj 0 0 0 rg ET 456.96 582.96 m 563.76 582.96 l 563.76 490.08 l 456.96 490.08 l 456.96 582.96 l 457.44 490.8 l 563.28 490.8 l 563.28 582.48 l 457.44 582.48 l 457.44 490.8 l 456.96 582.96 l h f* BT 0.8888 0 0 1 461.04 573.36 Tm /F0 6.96 Tf 0.2491 Tc 0.6524 Tw (Please draw a diagram of the) Tj 0 -8.4 TD 0.1528 Tc 0.7007 Tw (roadway or streets where the crash) Tj T* 0.236 Tc 0.6175 Tw (occurred, indicating the vehicles) Tj T* 0.2186 Tc 0.6349 Tw (involved and direction of travel) Tj T* 0.333 Tc 0.8405 Tw (using the following symbols:) Tj ET BT 481.2 531.36 TD /F1 6.96 Tf 0.1227 Tc 0.7773 Tw (= Direction) Tj 0 -8.4 TD -0.067 Tc 0.295 Tw (= Vehicle 1 \(Your Vehicle\)) Tj T* -0.0279 Tc 0.0879 Tw (= Vehicle 2) Tj -20.16 -8.4 TD 0.0149 Tc -0.1349 Tw ( O) Tj 20.16 0 TD 0.1849 Tc 0.9551 Tw (= Pedestrian/Non-motorist) Tj 0 -8.4 TD 0.1195 Tc 0.7805 Tw (= North) Tj ET 456.96 490.8 m 563.76 490.8 l 563.76 423.12 l 456.96 423.12 l 456.96 490.8 l 457.44 423.6 l 563.28 423.6 l 563.28 490.32 l 457.44 490.32 l 457.44 423.6 l 456.96 490.8 l h f* BT 461.04 481.2 TD /F0 6.96 Tf 0.0681 Tc 0.4959 Tw (Select one of the following if) Tj 0 -8.4 TD 0.0406 Tc 0.0194 Tw (the crash did not occur on a) Tj T* 0.0008 Tc -0.3008 Tw (public way:) Tj T* /F1 6.96 Tf 0.36 Tc 0 Tw (___) Tj 15.84 0 TD 0.0367 Tc 0.8633 Tw (Off-street parking lot) Tj -15.84 -8.4 TD 0.36 Tc 0 Tw (___) Tj 15.84 0 TD 0.1711 Tc (Garage) Tj -15.84 -8.4 TD 0.36 Tc (___) Tj 15.84 0 TD 0.2017 Tc 0.9383 Tw (Mall/shopping center) Tj -15.84 -8.4 TD 0.36 Tc 0 Tw (___) Tj 15.84 0 TD 0.0979 Tc 0.9221 Tw (Other private way) Tj ET 46.32 423.6 m 563.52 423.6 l 563.52 407.76 l 46.32 407.76 l 46.32 423.6 l h f* 46.08 423.84 m 563.76 423.84 l 563.76 407.52 l 46.08 407.52 l 46.08 423.84 l 46.56 408 l 563.28 408 l 563.28 423.36 l 46.56 423.36 l 46.56 408 l 46.08 423.84 l h f* BT 229.92 411.36 TD 1 1 1 rg /F0 11.04 Tf -0.1006 Tc 1.1806 Tw (Section H: Witness Information) Tj 0 0 0 rg ET 46.08 398.16 m 181.44 398.16 l 181.44 376.8 l 46.08 376.8 l 46.08 398.16 l 46.56 377.28 l 180.96 377.28 l 180.96 397.68 l 46.56 397.68 l 46.56 377.28 l 46.08 398.16 l h f* 46.08 408.48 m 181.44 408.48 l 181.44 397.68 l 46.08 397.68 l 46.08 408.48 l 46.56 398.16 l 180.96 398.16 l 180.96 408 l 46.56 408 l 46.56 398.16 l 46.08 408.48 l h f* BT 48.48 401.76 TD /F1 6.96 Tf 0.0287 Tc 0.8713 Tw (Witness Name \(Last, First, Middle\)) Tj ET 46.08 377.28 m 181.44 377.28 l 181.44 355.92 l 46.08 355.92 l 46.08 377.28 l 46.56 356.4 l 180.96 356.4 l 180.96 376.8 l 46.56 376.8 l 46.56 356.4 l 46.08 377.28 l h f* 180.96 408.48 m 472.8 408.48 l 472.8 397.68 l 180.96 397.68 l 180.96 408.48 l 181.44 398.16 l 472.32 398.16 l 472.32 408 l 181.44 408 l 181.44 398.16 l 180.96 408.48 l h f* BT 183.36 401.76 TD 0.3417 Tc 0 Tw (Address) Tj ET 180.96 398.16 m 472.8 398.16 l 472.8 376.8 l 180.96 376.8 l 180.96 398.16 l 181.44 377.28 l 472.32 377.28 l 472.32 397.68 l 181.44 397.68 l 181.44 377.28 l 180.96 398.16 l h f* 180.96 377.28 m 472.8 377.28 l 472.8 355.92 l 180.96 355.92 l 180.96 377.28 l 181.44 356.4 l 472.32 356.4 l 472.32 376.8 l 181.44 376.8 l 181.44 356.4 l 180.96 377.28 l h f* 472.56 408.48 m 563.76 408.48 l 563.76 397.68 l 472.56 397.68 l 472.56 408.48 l 473.04 398.16 l 563.28 398.16 l 563.28 408 l 473.04 408 l 473.04 398.16 l 472.56 408.48 l h f* BT 474.72 401.76 TD 0.312 Tc (Phone) Tj ET 472.56 398.16 m 563.76 398.16 l 563.76 376.8 l 472.56 376.8 l 472.56 398.16 l 473.04 377.28 l 563.28 377.28 l 563.28 397.68 l 473.04 397.68 l 473.04 377.28 l 472.56 398.16 l h f* 472.56 377.28 m 563.76 377.28 l 563.76 355.92 l 472.56 355.92 l 472.56 377.28 l 473.04 356.4 l 563.28 356.4 l 563.28 376.8 l 473.04 376.8 l 473.04 356.4 l 472.56 377.28 l h f* 46.32 356.88 m 563.52 356.88 l 563.52 341.04 l 46.32 341.04 l 46.32 356.88 l h f* 46.08 357.12 m 563.76 357.12 l 563.76 340.8 l 46.08 340.8 l 46.08 357.12 l 46.56 341.28 l 563.28 341.28 l 563.28 356.64 l 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