Forney Police Department Crash Report Request
1. Date and time of accident (if known): _________________________________________________________
2. Location of accident (if known):_______________________________________________________________
3. Name of any person involved (if known):________________________________________________________
4. Incident case number (if known):_______________________________________________________________
5.
The Forney Police Department must obtain the following information in order to determine if you are entitled to a
full and complete crash report in accordance with Texas Transportation Code §550.065(c)(4), effective 6/18/2015.
Persons or entities not listed under §550.065(c)(4) may only receive a crash report with redactions made in
accordance with §550.065(f)(2).
Printed Name: ___________________________________________________________ Date of Birth: __________________
Address: ________________________________________ City: ____________________ State: _____ Zip Code: _________
Perjury is a Class A misdemeanor under Texas Penal Code §37.02 and punishable by a fine not to exceed $4,000, up to a
year confinement in jail, or both such fine and confinement.
I declare u
nder penalty of perjury that the foregoing answers are true and correct.
Executed in Kaufman County, State of Texas, on the ________ day of _____________, ________.
____________________________________
Signature
Please select which of the below listed items apply to you in relationship to the crash report you are requesting. Please
be prepared to provide a valid government issued identification card, driver’s license, and/or other documentation.
I am the driver or any other person involved in the accident.
I am the authorized representative of any person involved in the accident.
Please list name of your client:
I am the employer, parent, or legal guardian of a driver involved in the accident.
Please list name of driver:
I am the owner of a vehicle or property damaged in the accident.
Please provide basic vehicle or property description:
I am a person who has established financial responsibility for a vehicle involved in the accident.
I am currently a representative or employee of an insurance company that issued an insurance
policy covering a vehicle or any person involved in the accident.
I am currently a person under contract to provide claims or underwriting information to a person
or entity described in the preceding two items.
I am currently a representative or employee of a radio station, television, or newspaper.
I am a person or entity who may sue because of death resulting from the accident.
I do not fall within any of the above categories. I am requesting a redacted crash report.
Pursuant to Sec. 550.065 "Release of Certain Information Relating to Accidents"
To obtain a copy of Crash Report:
1. Request is made in writing
2. The fee for a copy of a Crash Report is $6
3. The fee for a Certified Copy of a Crash Report is $8
Records Division Use Only: Report #________________________Records Personnel Initials:________
