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Alaska Motor Vehicle Crash Report Form 12-209
Beginning October 1, 2003:
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use for any collision where the damage is less than $1,000 OR
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any minor collisions where the suspect(s) are no longer on scene.
There are 2 ways to submit this report:
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Instructions for Filling out the form Online:
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You will be on a State web site called MyAlaska (this is the same place where you apply every year for your PFD)
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Enter your username and password if you already have one OR
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Sign up for an account with MyAlaska if you don’t already have one (New User tab)
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Click on the link Report a Vehicle Accident
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Agree to the State legal requirements page.
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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.
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Fill out the pages as they pop up.
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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).
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At the end of the process you can either save without submitting or submit the report by clicking the appropriate tab.
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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.
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You are finished and are now in compliance with Alaska law on reporting a vehicle collision.
Instructions for Mailing in the form:
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Fill in every possible block of requested information except for the DMV# and the "Official Use Only" blocks on the front side.
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Print the requested information clearly in the space provided.
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When a range of possible answers are provided on the form, darken the small circle adjacent to your choice.
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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).
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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."
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Follow the instructions and mailing address on the form.
Mail to:
Division of Motor Vehicles
PO Box 110221
Juneau, AK 99811-0221
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