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Are you familiar with Form Mv104? If not, you should be. This is the form that businesses use to file their annual reports with the state of Vermont. It's important to fill out this form accurately and on time, or you could face penalties. In this blog post, we'll go over everything you need to know about Form Mv104. We'll explain what information is required on the form, and we'll also provide some helpful tips on how to complete it.

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Question	Answer
Form Name	Form Mv104
Form Length	2 pages
Fillable?	Yes
Fillable fields	161
Avg. time to fill out	32 min 46 sec
Other names	nys motor vehicle, mv104, mv 104 form, dmv mv 104

12

Form Preview Example

MV-104 (5/11) PAGE 1 of 2

FOLD

HERE

New York State Department of Motor Vehicles

Use only for accidents that

REPORT OF MOTOR VEHICLE ACCIDENT

happen in New York State

www.dmv.ny.gov

BEFORE COMPLETING THIS FORM, READ THE INSTRUCTIONS IN SECTION A ON PAGE 2

DO NOT FORGET

Page _______ of _______

RUSH - DRIVER OF VEHICLE 1 - LICENSE SUSPENDED FOR FAILURE TO REPORT

ACCIDENT DATE

Accident Date

Day of Week

Time

AM

Number of

Number

Number

Did police investigate

If “Yes”, Name of Police Agency or Precinct & Accident Number

Month

Day

Year

Vehicles

Injured

Killed

accident at scene?

PM

Yes

No

DRIVER OF VEHICLE 1

VEHICLE 2

PEDESTRIAN

BICYCLIST

OTHER PEDESTRIAN

0

Driver License ID Number

State of License

Driver License ID Number

State of License

Driver Name–exactly as printed on license (Last, First, M.I.)

Name–exactly as printed on license (Last, First, M.I.)

<![endif]>DRIVER

City or Town

State

Zip Code

City or Town

State

Zip Code

Address (Include Number & Street)

Apt. Number

Address (Include Number & Street)

Apt. Number

Date of Birth

Sex

Number of

Public

Date of Birth

Sex

Number of

Public

Month

Day

Year

People in

Property

Month

Day

Year

People in

Property

Vehicle

Damaged

Vehicle

Damaged

@

Name–exactly as printed on registration

Date of Birth

Sex

Name–exactly as printed on registration

Date of Birth

Sex

Month

Day

Year

Month

Day

Year

<![endif]>REGISTRANT

Address (Include Number & Street)

Apt. Number

Address (Include Number & Street)

Apt. Number

City or Town

State

Zip Code

City or Town

State

Zip Code

Plate Number

State of Reg.

Vehicle Year & Make

Vehicle Type

Ins. Code

Plate Number

State of Reg.

Vehicle Year & Make

Vehicle Type

Ins. Code

Estimated Cost of Property Damage - Vehicle 1

Estimated Cost of Property Damage - Vehicle 2

$1,001-$1,500

$1,501-$2,500

Over $2,500

$1,001-$1,500

$1,501-$2,500

Over $2,500

<![endif]>DAMAGE

Describe damage to vehicle 1

ACCIDENT DIAGRAM: Circle one of the 9 diagrams (numbered 0-8) if it

Left Turn

Rear End

Sideswipe

Describe damage to vehicle 2

describes the accident, or draw your own diagram below in space #9.

(same direction)

Number the vehicles. Your vehicle is # 1

0.

1.

2.

Left Turn

Right Angle

Right Turn

<![endif]>VEHICLE

3.

4.

5.

Right Turn

Head On

Sideswipe

9.

(opposite direction)

6.

7.

8.

0

Place Where Accident Occurred in New York State:

Permanent Landmark___________________

<![endif]>LOCATION

County ______________________

City

Village

Town

of __________________________________.

Road on which accident occurred _____________________________________________________________________________________________________________

(Route Number or Street Name)

at

1) intersecting street______________________________________________________________________________________________________________________

N

S

(Route Number or Street Name)

or

2) __________ __________

______________________________________________________________________________________

<![endif]>ACCIDENT

E

W

of

Feet

Miles

(Milepost, Nearest intersecting Route Number or Street Name)

How did the accident happen?

5

8. Which Veh.

9. Position

10. Safety

12.

13.

16. Injury

If Deceased, Enter

Names of All Persons Involved

Occupied

in/on Vehicle

Equip.Used

Age

Sex

A

B

C

Describe Injuries

Date of Death

<![endif]>ALL INVOLVED

6

Identify Damaged Property

VIN

<![endif]>INSURANCE

Other Than Vehicle(s)

Name of Insurance Company

Policy

That Issued Policy For Vehicle 1

Number

Name and Address of

Policy Period

Policy Holder

From

To

If Vehicle was Operated Under Permit

Name and Address

(ICC, USDOT or NYSDOT), give No.

of Permit Holder

If Self-Insured, give

and State

Certificate No.

Date

Print Name of Driver

Signature of Driver

(or Representative*)

(or Representative*) •

of Vehicle 1

of Vehicle 1

A representative may sign for the driver if the driver is unable to sign

Injury

An accident report is not considered complete and filed unless it is signed,

because*

of injury or death. If you are signing as the driver’s representative,

and if not signed may result in the suspension of your driver’s license.

check the box that describes why the driver cannot sign.

Death

1

2

3

4

5

6

7

23

24

25

26

27

28

29

30

reset/clear

THE REPORT MUST BE SIGNED BY THE DRIVER OF VEHICLE 1, UNLESS HE

MV-104 (5/11) PAGE 2 of 2	SECTION A

You must report within 10 days any accident occurring in New York State causing a fatality, personal injury or damage over $1,000 to the property of any one person. Failure to do so within 10 days is a misdemeanor. Your license and/or registration may be suspended until a report is filed. Check the “RUSH” box at the top of page 1 if your license is suspended for failure to report this accident on time. You must fill in all information requested on the report.

Then fill in the boxes numbered 1-7 and 23-30 in the right margin on page 1 by entering the number of the item from Section B that best describes the circumstances of the accident. If a question does not apply, enter a dash (“-”). If you do not know an answer, enter an “X”.

INSTRUCTIONS - PLEASE PRINT OR TYPE ALL INFORMATION - USE BLACK INK

* First — fold along this shaded, dotted line.*

*Don’t fold internet form. Instead, place page 2 over page 1, with the arrows on page 2 pointing to the boxes on the right edge of page 1.

VEHICLE INVOLVEMENT - If you were in an accident involving:

�two-cars, enter your information in the VEHICLE 1 section and the other driver’s information in the VEHICLE 2 section.

�a pedestrian, bicyclist or other pedestrian (a person using a non-motorized conveyance such as in-line skates, skateboard,sled, etc.), enter the information in the “Driver” spaces provided for Vehicle 2, and check the PEDESTRIAN, BICYCLIST or OTHER PEDESTRIAN box.

�a vehicle other than a motor vehicle (such as a snowmobile, mini-bike, aircycle, all-terrain vehicle, trail bike, or other non-motor vehicle), enter the driver, registrant and vehicle information in the space provided for VEHICLE 2.

�an unoccupied vehicle, enter all available information. Be sure to enter the correct vehicle Plate Number and Vehicle Type in the VEHICLE 2 block.

�more than two vehicles, fill out additional accident reports. On these reports, place the information for the third vehicle in the space marked VEHICLE 1 and mark it # 3. Use the space marked VEHICLE 2 for the fourth vehicle, and mark it # 4 and so on. Additional forms are available at any Motor Vehicles office or from the DMV website: www.dmv.ny.gov.

0DRIVER - Enter the information for each driver EXACTLY as it appears on his/her driver license.

@REGISTRANT - Enter registrant information EXACTLY as it appears on the registration of each vehicle involved in the accident.

¸VEHICLE DAMAGE - Indicate if the accident exceeds the $1,000 threshold for property damage to any one vehicle or property caused by the accident, and describe the vehicle damage.

0 ACCIDENT LOCATION - Enter the county, locality and street(s) where the accident occurred. Check the box if there is an intersecting street. If available, identify a permanent landmark nearby, such as a business, school, shopping mall, parking lot, water tower, railroad, mountain or cell tower.

0 ALL INVOLVED - List the names of all persons involved in the accident, and provide the date of death if anyone was killed in, or as a result of, the accident. If more than four people are involved, complete another report. In the ALL INVOLVED section of that report, provide the required information for everyone else involved in the accident. Enter the following codes in the appropriate columns:

WHICH VEHICLE OCCUPIED (Column 8) - Enter the appropriate number or letter.

1. Vehicle 1

2. Vehicle 2

B. Bicyclist

P. Pedestrian

O. Other Pedestrian

POSITION IN/ON VEHICLE (Column 9) - Enter the number from this

8

diagram which corresponds to each person’s position.

4

1

1. Driver 2-7. Passengers

8. Riding/Hanging on Outside

8

7

5

2

8

SAFETY EQUIPMENT USED (Column 10)

6

3

8

In-Line Skater/Bicyclist

1. None

7. Air Bag Deployed

2. Lap Belt

8. Air Bag Deployed/Lap Belt

C.Helmet Only

3. Shoulder Restraint

9. Air Bag Deployed/Shoulder Restraint

4. Lap Belt Restraint

A. Air Bag Deployed/ Lap Belt/Restraint

D.Helmet/Other

E.Pads Only

5. Child Restraint Only

B. Air Bag Deployed/Child Restraint

F. Stoppers Only

6. Helmet (Motorcycle Only) O. Other

INJURY (Columns 16A-C) - Check all column(s) that apply and DESCRIBE INJURIES:

A - Severe lacerations, broken or distorted limbs, skull fracture, crushed chest, internal

injuries, unconscious when taken from the accident scene, unable to leave accident

scene without assistance.

B - Lump on head, abrasions, minor lacerations.

C - Momentary unconsciousness, limping, nausea, hysteria, complaint of pain (no visible

injury), whiplash (complaint of neck and head pain).

�INSURANCE - Enter damage to private property, if any, insurance policy information and VIN.

Attach additional reports to page one. Each page of the report must be numbered in the upper left corner. Mark additional sheets #2, #3, etc. Date and sign on the bottom line of each attached report.

OR SHE IS UNABLE TO SIGN BECAUSE HE/SHE IS INJURED OR DECEASED.

Send original to: CRASH RECORDS CENTER 6 EMPIRE STATE PLAZA PO BOX 2925

ALBANY NY 12220-0925

SECTION B

Be sure your

answers are marked

USE TO COMPLETE

INSIDE THE

BOXES 1-7 and 23-30 ON PAGE 1

BOXES ON

PAGE

PEDESTRIAN/BICYCLIST/OTHER PEDESTRIAN LOCATION

1. Pedestrian/Bicyclist/Other Pedestrian at Intersection

1

2. Pedestrian/Bicyclist/Other Pedestrian Not at Intersection

PEDESTRIAN/BICYCLIST/OTHER PEDESTRIAN ACTION

1

1. Crossing, With Signal

2. Crossing, Against Signal

3. Crossing, No Signal, Marked Crosswalk

4. Crossing, No Signal or Crosswalk

5. Riding/Walking/Skating Along Highway With Traffic

6. Riding/Walking /Skating Along Highway Against Traffic

2

7. Emerging from in Front of/Behind Parked Vehicle

8. Going to/From Stopped School Bus

9. Getting On/Off Vehicle Other Than School Bus

11. Working in Roadway

12. Playing in Roadway

13. Other Actions in Roadway

14. Not in Roadway

TRAFFIC CONTROL

10. RR Crossing Gates

1.

None

2.

Traffic Signal

11. Stopped School Bus-Red

3.

Stop Sign

Lights Flashing

4.

Flashing Light

12. Construction Work Area

5.

Yield Sign

13. Maintenance Work Area

3

6.

Officer/Guard

14. Utility Work Area

7.

No Passing Zone

15. Police/Fire Emergency

8.

RR Crossing Sign

16. School Zone

9.

RR Crossing Flashing Light 20. Other

LIGHT CONDITIONS

1.

Daylight

3. Dusk

5.Dark-Road Unlighted

4

2.

Dawn

4. Dark-Road Lighted

ROADWAY CHARACTER

1.

Straight and Level

4. Curve and Level

5

2.

Straight and Grade

5. Curve and Grade

3.

Straight at Hillcrest

6. Curve at Hillcrest

ROADWAY SURFACE CONDITION

1.

Dry

3.

Muddy

5.

Slush

0.

Other

6

2.

Wet

4.

Snow/Ice

6.

Flooded

WEATHER

2. Cloudy

5.

Sleet/Hail/Freezing Rain

1. Clear

3. Rain

6. Fog/Smog/Smoke

7

4. Snow

0. Other

DIRECTION OF TRAVEL

N

NE

Veh.

NW

1

1.

North

5.

South

1. 23

8

2

2.

Northeast

6.

Southwest

W

7

3

E

3.

East

7.

West

4.

Southeast

8.

Northwest

6

5

4

Veh.

SW

S

SE

2 24

PRE-ACCIDENT VEHICLE ACTION

1. Going Straight Ahead

11. Avoiding Object in Roadway

2. Making Right Turn

12. Changing Lanes

Veh.

3. Making Left Turn

13. Passing

1 25

4. Making U Turn

14. Merging

5. Starting from Parking

15. Backing

6. Starting in Traffic

16. Making Right Turn on Red

7. Slowing or Stopping

17. Making Left Turn on Red

Veh.

8. Stopped in Traffic

18. Police Pursuit

2 26

9. Entering Parked Position

20. Other

10. Parked

LOCATION OF FIRST EVENT

27

1. On Roadway

2. Off Roadway

TYPE OF ACCIDENT

COLLISION WITH

1. Other Motor Vehicle

6. In-Line Skater

First

2. Pedestrian

7. Deer

28

3.

Bicyclist

8. Other Pedestrian

Event

10. Other Object (Not Fixed)

4. Animal

5. Railroad Train

COLLISION WITH FIXED OBJECT

11. Light Support/Utility Pole

21. Median - Not At End

12. Guide Rail - Not At End

22. Snow Embankment

13. Crash Cushion

23. Earth Embankment/

Veh.29

14. Sign Post

Rock Cut/Ditch

1

15. Tree

24. Fire hydrant

Second

16. Building/Wall

25. Guide Rail - End

Event

17. Curbing

26. Median - End

Veh.

18. Fence

27. Barrier

2 30

19. Bridge Structure

30. Other Fixed Object

20. Culvert/Head Wall

NO COLLISION

31. Overturned

33. Submersion

32. Fire/Explosion

34. Ran Off Roadway Only

40. Other

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filling in dmv new york part 1

Type in the requested information in Describe, damage, to, vehicle Left, Turn Rear, End Sideswipe, same, direction Describe, damage, to, vehicle Left, Turn Right, Angle Right, Turn Right, Turn Head, On Sideswipe, opposite, direction Village, Town, City, and Permanent, Landmark field.

dmv new york Describedamagetovehicle, LeftTurn, RearEnd, Sideswipesamedirection, Describedamagetovehicle, LeftTurn, RightAngle, RightTurn, RightTurn, HeadOn, Sideswipeoppositedirection, Village, Town, City, and PermanentLandmark fields to insert

You will be asked to type in the particulars to let the platform prepare the section EC, NARU, SN If, Self, Insured, give, Certificate, No Name, and, Address, of, Permit, Holder Policy, Number, Policy, Period From, and, State Date, Injury, Death, and Reset, Clear

Filling in dmv new york step 3

You will have to define the rights and responsibilities of both parties in box DRIVER, ACCIDENT, LOCATION ALL, INVOLVED Vehicle, B, Bicyclist P, Pedestrian O, Other, Pedestrian Passengers, Riding, Hanging, on, Outside InLine, Skater, Bicyclist Dusk, Dark, Road, Lighted Dark, Road, Un, lighted ROADWAY, SURFACE, CONDITION Dry, Wet Muddy, Snow, Ice Slush, Flooded and Other.

step 4 to entering details in dmv new york

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