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Alaska Motor Vehicle Crash Report Form 12-209

Beginning October 1, 2003:

  1. use for any collision where the damage is less than $1,000  OR
  2. any minor collisions where the suspect(s) are no longer on scene.

There are 2 ways to submit this report:

  1. Fill out the form Online
  2. Download the form and Mail in
Instructions for Filling out the form Online:
  1. Click on the following link http://reportcrash.alaska.gov/
  2. You will be on a State web site called MyAlaska (this is the same place where you apply every year for your PFD)
  3. Enter your username and password if you already have one OR
  4. Sign up for an account with MyAlaska if you don’t already have one (New User tab)
  5. Click on the link Report a Vehicle Accident
  6. Agree to the State legal requirements page.
  7. You will now be inside the application and see a summary of how the various pages for reporting an accident will be presented to you.
  8. Fill out the pages as they pop up.
  9. At the end of the process you should print a copy for your records by clicking on the print PrintForm tab and saving the PDF file to your computer (you will need the Accident Number from this document).
  10. At the end of the process you can either save without submitting or submit the report by clicking the appropriate tab.
  11. Please write down the Form Number in the file name of the PDF document you downloaded in step 9 to give to your insurance company as the Accident Number.
  12. You are finished and are now in compliance with Alaska law on reporting a vehicle collision.
Instructions for Mailing in the form:
  1. Download and print the Alaska Motor Vehicle Crash Report form.  You will need free Adobe Acrobat Reader to view this form. 
  2. Fill in every possible block of requested information except for the DMV# and the "Official Use Only" blocks on the front side.
  3. Print the requested information clearly in the space provided.
  4. When a range of possible answers are provided on the form, darken the small circle adjacent to your choice.
  5. In the space where Street or Highway is requested, first write in the street you were traveling on, then make the appropriate reference to a cross street.  If your vehicle was in a parking lot or a street address, use the closest cross streets and provide the direction and distance.  You may provide the street address in your narrative (crash description).
  6. Use concise language in your crash description. Example:  "My car was parked unoccupied facing West on East 4th Ave., approximately 50 ft. East of D St. It was struck in the front bumper between 0700 and 1000 hrs."
  7. Follow the instructions and mailing address on the form.Mail to: Division of Motor VehiclesPO Box 110221Juneau, AK  99811-0221