Police & Accident Report Request Form

Accident Report and Police Report Request Form

Accident Reports Fee…………. $15.00
Incident Reports Fee……...…… .25 per page (Fees will be calculated based on number of pages in the report)

Please complete all sections below and sign. ONLY one report per request form.
Please provide as much information as possible.

Please make check payable to "City of Johnstown" and send Checks and Money Orders to:

401 Washington Street
Johnstown, PA 15901

First Name *

Last Name *

Street Address *

City / State / Zip Code *

Phone Number *

Email Address *

Date of Incident *

Month

Day

Year

Incident Report # *

Location of Incident *

Other Party Involved

Please provide in complete detail your reason for requesting a copy of this report: *

Driver's License Number *

Driver's License State *

I certify that I am: *

Named In The Report

An Insurance Agent

A Government Agency

Check the 'I Agree' checkbox to certify that you are named in the report.

If Insurance Agent or Government Agency, please provide name below:

Signature (Type Full Name) *

Today's Date *

Month

Day

Year

Leave this field blank