Form MV-104F.1 - Accident Report for School Vehicles - New York
ALL PERSONS INJURED OR KILLED
Provide Information for Every Person Injured or Killed in Accident (Continued from MV-104F)
Name of All Persons Injured or Killed
Describe Injuries
If Deceased, Enter
Date of Death
INJURY SECTION
Check proper column(s).See instruction 7 on Page 6.
Which
Veh. Occ.
Safety
Equip. Used Age Sex
Seated/
Standing
AB C
MV-104F.1 (5/07)
New York State Department of Motor Vehicles
ACCIDENT REPORT FOR SCHOOL VEHICLES
TRANSPORTING PUPILS/TEACHERS/SUPERVISORS
Continuation Sheet Page _______ of _______ Pages
Accident Date (Month/Day/Year) County of Accident School Bus Plate NumberLast Name of School Bus Driver First M.I.
ATTACH TO COPY 1 OF FORM MV-104F
ACCIDENT REPORT FOR SCHOOL VEHICLES TRANSPORTING PUPILS/TEACHERS/SUPERVISORS.
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