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Get VT TA-VA-04 2012

M VEHICLE DESCRIBE IN YOUR OWN WORDS WHAT HAPPENED (ATTACH SHEET IF NECESSARY) WAS THIS CRASH INVESTIGATED BY AN OFFICER? Yes No IF YES, GIVE NAME OF OFFICER: OFFICER’S DEPARTMENT: WERE YOU DRIVING A COMMERCIAL VEHICLE? Yes WAS THE VEHICLE TRANSPORTING HAZARDOUS MATERIALS? No Yes No IF YES, GIVE NAME OF MATERIAL DATE OF REPORT OPERATOR SIGN HERE CONTINUE ON NEXT PAGE IMPORTANT: YOU MUST FURNISH THE INSURANCE INFORMATION REQUESTED. Vermont law requires that any person involved.

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