T by the operator's supervisor. Sections XI thru XIII are filled out by an accident investigator for bodily injury, fatality, and/or damage exceeding $500. SECTION I - FEDERAL VEHICLE DATA 1. DRIVER'S NAME (Last, first, middle) 2. DRIVER'S LICENSE NO./STATE/LIMITATIONS 3. DATE OF ACCIDENT 4a. DEPARTMENT/FEDERAL AGENCY PERMANENT OFFICE ADDRESS 4b. WORK TELEPHONE NUMBER ( 5. TAG OR IDENTIFICATION NUMBER 6. EST. REPAIR COST 7. YEAR OF VEHICLE 8. MAKE ) 9. MODEL 10. SEAT BELTS USED YES NO.
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