Online Crash Form Instructions

  • Help is available for every field by clicking the field for that particular field.

    12209 Help Image

  • You will complete a number of screens, depending upon the number of vehicles and people involved in the crash.

  • Please DO NOT print each screen or page. You will have the ability to print the entire form in Adobe PDF file format once you have completed ALL the necessary screens.

  • Your data on the screen is not saved until you click the "Save and Continue" button.

  • 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. Again, you will have the ability to print the completed form after completing ALL the necessary screens.

  • Mail signed form to:

    DMV Main Office
    P.O. Box 110221
    Juneau, AK 99811-0221

Go to the 12-209 entry application

The 12209 entry application is off line for maintenance and will be back up as soon as possible.

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)

  • Go to the online Certificate of Insurance form

  • Manual Crash Form Instructions:

  • Please read thoroughly before completing the paper form.

  • Download the form Download Adobe Reader

  • Only complete the manual form if experiencing problems with the online form above.

  • You can complete the form by filling it out on your computer and printing it, or printing the blank form and filling it out by hand. For clarity and efficient processing, filling it out on your computer and printing it is preferred.

  • REQUEST a crash number by calling the Alaska Department of Transportation & Public Facilities, Crash Data Team at 907-465-5643 (Monday-Friday 7:30 am - 4:00 pm Alaska Time). Enter the number at the top of the form after the SR#.

  • The above contact number is ONLY for crash number assignment. All other inquiries regarding filling out the form should be directed to DMV (907-465-4361).

  • Complete the form, sign it and make a copy for your records.

  • 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.