Late Reported Accident Form (online submission)

The information produced as a result of this request is for documentation purposes only.  At no point will an officer be assigned to investigate this incident.  Per Vermont statute (T23 VSA 1129a), the operator of every motor vehicle involved in a crash which results in injury or death or total property damage of $3,000 or more, must make a report to the State of Vermont Agency of Transportation.  See here for more details.

Please provide as much information as possible.

Date of Accident:

Time of Accident:

Location of Crash:

Owner/Operator Last Name:

Owner/Operator First Name:

Owner/Operator Middle Initial:

Owner/Operator Address (Street, City, State, Zip):

Owner/Operator Date of Birth:

Owner/Operator Driver License Number:

Owner/Operator License State:

Owner/Operator Vehicle Year, Make, and Model:

Owner/Operator Vehicle Registration (Plate) Number:

Owner/Operator Vehicle Registration State:

Owner/Operator Phone Number:

Owner/Operator E-mail address:

Damage to your vehicle:

Approximate Dollar Value of Damage to your vehicle:

Other Operator and Vehicle Information (if known):

Damage to other vehicle (if known) - include the approximate dollar value of damage:

By checking this box, you confirm that the information you are submitting is true. It is a crime to make false reports to police