Minneapolis Police Department Accident Report Request Form
Case Control Number: MP
Note: The accident report may not be located without the CCN
Date of Accident:
Location/Intersection of Accident:
Name(s) of person(s) involved in accident:
Name of Requester:
Email Address of Requester:
Address of Requester (include name of law firm or insurance firm, if applicable):
An Accident Report can only be provided to an Authorized Requestor. Please select from
the following list of five categories of Authorized Requesters.
Category 1: A person involved in the accident
State Nature of Involvement (e.g., driver, passenger, pedestrian, vehicle owner etc.)
Category 2: If a person involved in the accident is deceased, the representative of
th
e estate of the deceased, or the surviving spouse of the deceased, or the next of ki
n
o
f the deceased, or the trustee of the deceased
State Nature of Relationship to the Deceased
Note: A death certificate must be provided. Legal representation document is also required.
Category 3: A person injured in person, property, or means of support orwho
incurs other pecuniary loss because of the accident
State Nature of injury or nature of pecuniary loss
MP-9092
Minneapolis Police Department Accident Report Request Form
Category 4: Legal counsel of any person described in Categories 1, 2 or 3.
Category 5: A representative of the insurer of any person described in Categories
1,
2 or 3.
State Claimant Name(s) and Claim(s) Number:
By signing below, I certify that the information and statements on this Accident
Report Request Form are true and correct. I understand that disclosing any
information contained in any accident report, except as provided in Minnesota
Statutes, Sections 169.09, subd. 13 and 13.82, subds. 3 or 6, or other statutes, is
a misdemeanor.
Signature of Authorized Requester
: Date:________________
Requests will not be processed without a signature from an authorized
requester
Checks and Money Orders can be made payable to the City of Minneapolis
Pre-paid accounts are available for high volume requesters
R
eports can be obtained in person or by mail at:
Minneapolis Police Records Information Unit,
350 S. 5
th
Street, City Hall Room 31
Minneapolis, Minnesota 55415.
For questions, call (612) 673- 2961.
For office use only:
Comments: Search made No Report Made Operator initials:
MP-9092
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