Welcome - you have reached the site where you can fill out a 12209 crash report form or a certificate of insurance. Please read the instructions and then click on the appropriate form.
Online Crash Form Instructions
- Help is available for every field by clicking the label for that particular field.
- You will complete a number of screens, depending upon the number of vehicles and people involved in the crash.
- After completing the entire form you will be presented with a final version in Adobe PDF format.
- Your browser session will time out after a period of inactivity. If this happens then you will be required to begin again.
- Upon completion, you MUST print, sign and mail the completed form to the DMV. You will have the ability to print the completed form after completing ALL the necessary screens.
- Mail signed form to (this address is also on the completed form):
DMV Main Office
P.O. Box 110221
Juneau, AK 99811-0221
Online Certificate of Insurance Instructions:
- Fill out this form only if the police have investigated your crash and you were instructed to complete a CERTIFICATE OF INSURANCE and send to the DMV.
- Complete the form, print it, sign it and make a copy for your records.
- Mail the signed certificate to the DMV (see address above)
Manual Crash Form Instructions:
- Please read thoroughly before completing the paper form.
- Only complete the manual form if experiencing problems with the online form above.
- Print the Form (this form contains an automatically generated SR Number) Inquiries or assistance regarding the SR number should be Directed to DOT&PF at: email@example.com
- Inquiries or assistance regarding filling out the form should be directed to DMV (907-465-4361).
- Print the form and complete by hand.
- Mail the original form to the address listed on page 2 of the form, which is the same as the address listed above. Please note that the DMV does not acknowledge receipt of crash forms, but they will contact you if they need further information.
- You can email questions to: firstname.lastname@example.org