Fillable Failure to Report a Vehicle Crash Affidavit (Department of Motor Vehicles )

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Failure to Report a Vehicle Crash Affidavit (Department of Motor Vehicles )

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Central Services Division
555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Fax: (775) 684-4829
dmvnv.com
DLD-68 (Revised 9/2016)
Signatures must be originals. Photocopies are not acceptable
.
Changes may not be made to this form once it is signed.
Failure to Report a Vehicle Crash Affidavit
(NRS 484E.070)
Case Number:
Crash Date:
Location:
I, the undersigned, being first duly sworn, depose and state:
1. I did not willfully fail to report the above-mentioned crash to the Department of Motor Vehicles,
Central Services, Financial Responsibility.
2. I am aware that action may be taken against me if it is subsequently determined I did willfully fail
to report the crash to the Department of Motor Vehicles, Central Services, Financial
Responsibility.
Signed and sworn to before me this
day of
20
day
month
By
Notary Public or Authorized Nevada DMV Representative
Signature:
Mailing address:
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Failure to Report a Vehicle Crash Affidavit (Department of Motor Vehicles )

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Completed 24 December 2020

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