Form PS2503-13 "Minnesota Crash Record Request" - Minnesota

What Is Form PS2503-13?

This is a legal form that was released by the Minnesota Department of Public Safety - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Minnesota Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PS2503-13 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Public Safety.

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Download Form PS2503-13 "Minnesota Crash Record Request" - Minnesota

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MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Print Form
DRIVER AND VEHICLE SERVICES
MIN NE SOT A C RAS H REC O RD R EQ UEST
Reports can be obtained in person or by mail at Driver and Vehicle Services, 445 Minnesota Street, St. Paul, MN 55101-5161.
For questions, call (651) 296-2940. Please complete the form with all required areas or it will be returned.
• A $5.00 fee is due for each requested copy or search (when not found).
• Checks/money orders should be made payable to: Driver and Vehicle Services
• Requests will not be processed without a signature from an authorized requestor.
If mailing in: Requester must include a legible copy of driver license, government issued identification
card, or notarized signature.
Crash Information (
):
Law Enforcement Case #
PRINT OR TYPE
Person(s) Involved
(first, middle, last name)
Date of Birth
Driver License Number
License Plate Number *
1.
2.
3.
* Without listing license plate numbers, the requested report may not be located.
Location of Crash (Street or Highway)
County
Date of Crash (mm/dd/yy)
Check one box for authorized requestor:
Driver
Owner of Damaged Property
Printed Name of Authorized Requestor
Passenger
Owner of Vehicle
Company Name
Pedestrian
Insurance Representative
Next of Kin
Client Name:
Legal Representative
Client Name:
Please note: In the case of a fatality, the next of kin, or legal
representative must provide proof of death, such as a death
certificate, obituary, or memorial card.
Certification: I (we) certify that the information and statements on this
request are true and correct, and comply with the provisions of Minn. Stat. §
169.09. I (we) understand that disclosing any information contained in any
crash report, except as provided in Minn. Stat. §§ 169.09, Subd. 13, 13.82,
Subd. 3 or 6, or other statutes is a misdemeanor.
Mail Report
Back to:
X
Signature of Authorized Requester
SUBSCRIBED AND SWORN BEFORE ME THIS
DAY OF
, 20
NOTARY PUBLIC
COUNTY
MY COMMISSION EXPIRES
NOTARY STAMP
For office use only:
Comments:
No File(s) Located
Search made - No police report available
PS2503-13 (05/2019)
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Print Form
DRIVER AND VEHICLE SERVICES
MIN NE SOT A C RAS H REC O RD R EQ UEST
Reports can be obtained in person or by mail at Driver and Vehicle Services, 445 Minnesota Street, St. Paul, MN 55101-5161.
For questions, call (651) 296-2940. Please complete the form with all required areas or it will be returned.
• A $5.00 fee is due for each requested copy or search (when not found).
• Checks/money orders should be made payable to: Driver and Vehicle Services
• Requests will not be processed without a signature from an authorized requestor.
If mailing in: Requester must include a legible copy of driver license, government issued identification
card, or notarized signature.
Crash Information (
):
Law Enforcement Case #
PRINT OR TYPE
Person(s) Involved
(first, middle, last name)
Date of Birth
Driver License Number
License Plate Number *
1.
2.
3.
* Without listing license plate numbers, the requested report may not be located.
Location of Crash (Street or Highway)
County
Date of Crash (mm/dd/yy)
Check one box for authorized requestor:
Driver
Owner of Damaged Property
Printed Name of Authorized Requestor
Passenger
Owner of Vehicle
Company Name
Pedestrian
Insurance Representative
Next of Kin
Client Name:
Legal Representative
Client Name:
Please note: In the case of a fatality, the next of kin, or legal
representative must provide proof of death, such as a death
certificate, obituary, or memorial card.
Certification: I (we) certify that the information and statements on this
request are true and correct, and comply with the provisions of Minn. Stat. §
169.09. I (we) understand that disclosing any information contained in any
crash report, except as provided in Minn. Stat. §§ 169.09, Subd. 13, 13.82,
Subd. 3 or 6, or other statutes is a misdemeanor.
Mail Report
Back to:
X
Signature of Authorized Requester
SUBSCRIBED AND SWORN BEFORE ME THIS
DAY OF
, 20
NOTARY PUBLIC
COUNTY
MY COMMISSION EXPIRES
NOTARY STAMP
For office use only:
Comments:
No File(s) Located
Search made - No police report available
PS2503-13 (05/2019)