CITY OF PHILADELPHIA - DEPARTMENT OF RECORDS
APPLICATION FOR
TRAFFIC ACCIDENT REPORT OR PHOTOGRAPH 		DATE OF APPLICATION (PLEASE ALLOW 2 TO 3 WEEKS FROM DATE OF ACCIDENT)
NAME OF APPLICANT

 

 		TELEPHONE NUMBER OF APPLICANT

 
ADDRESS                                                      CITY                                    STATE           ZIP CODE

 

 		DATE OF ACCIDENT

 
LOCATION OF ACCIDENT

 

DATE ACCIDENT REPORTED TO POLICE

 
PERSON(S) INVOLVED (DRIVER OF VEHICLE)

 

 		YOUR CLAIM, POLICY OR FILE NUMBER (OPTIONAL)

 
PERSON(S) INVOLVED (DRIVER OF VEHICLE, PEDESTRIAN, ETC.)

 

 		ACCIDENT INVESTIGATION DIVISION NUMBER

 
DISTRICT CONTROL NUMBER

 

 		PHILADELPHIA CODE

 

 		 
COPIES OF FEE NO. APPLICANT'S FEE
  TRAFFIC ACCIDENT REPORT 25.00 EACH   25.00 
   PHOTOGRAPHS AVAILABLE FOR SUBJECT ACCIDENT $27.00
FIRST PRINT  		   $
$9.00 EACH
ADD'L PRINT  		   $
FEE NOT REFUNDABLE MAIL THIS PORTION WITH APPROPRIATE FEE TOTAL
25.00
PLEASE SEND 2 SELF-ADDRESSED, STAMPED ENVELOPES.

IF YOU HAVE A DISABILITY AND REQUIRE AN ACCOMMODATION IN ORDER TO COMPLETE THIS FORM AND/OR TO PARTICIPATE IN A PROGRAM OR SERVICE, CONTACT THE ADA COORDINATOR AT 686-2266.

82-23 (rev. 8/97)

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CITY OF PHILADELPHIA - DEPARTMENT OF RECORDS

FACT SHEET ABOUT REQUESTS FOR AUTOMOBILE ACCIDENT REPORTS

 

PLEASE RETAIN THE BOTTOM PORTION OF FORM FOR YOUR FILES. NOTE THE DATE THAT YOU MAILED YOUR REQUESTS, DISTRICT CONTROL NUMBER, PHILADELPHIA CODE AND ANY OTHER INFORMATION THAT MAY BE PERTINENT TO YOU.

 

DISTRICT CONTROL NO./PHILA. CODE

NAME(S) OF DRIVERS/FILE NO.

DATE MAILED
 
________________________ ________________________________ _________________

 

It is essential that the information provided on this application is accurate.  Information should contain the following: Date of accident, name of driver(s), location of accident, district control number and the Philadelphia Code.  The district control number and the Philadelphia code can be obtained by calling the police district where the accident occurred.   Insufficient or vague information may result in a negative response.

All Inquiries are made and mail is sent to:

Department of Records

Traffic Accident Reports

Room 167, City Hall

Philadelphia, PA 19107

(215) 686-2266

 

TO EXPEDITE SERVICE, PLEASE SEND 2 SELF-ADDRESSED, STAMPED ENVELOPES.

MAKE CHECKS OR MONEY ORDERS PAYABLE TO "CITY OF PHILADELPHIA"


FEE NOT REFUNDABLE

PLEASE ALLOW 2 TO 3 WEEKS FROM DATE OF ACCIDENT BEFORE APPLYING FOR COPIES.

 

THANK YOU FOR APPLYING BY MAIL