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INJURIES Did above go to the hospital Yes No Name of hospital Transported by ambulance Yes No Name of ambulance service Any other medical treatment 2 Page IF APPLICABLE PROPERTY DAMAGE IS YOUR VEHICLE DRIVABLE Yes No Estimated Damage WHERE IS YOUR VEHICLE LOCATED Your vehicle s year make model and color Your vehicle plate number Who is the owner of your vehicle Did you take pictures of your car Yes No Auto Insurance Provider Policy Claim Adjuster Telephone DEFENDANT INSURANCE INFORMATION Driver...

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