Form Ta W4310 PDF Details

When someone is involved in an accident on the New York State Thruway System, obtaining a copy of the police accident report is a necessary step for a variety of reasons, ranging from insurance claims to legal matters. The TA-W4310 form serves as a formal request to acquire this critical document. It necessitates the completion of sections detailing requester information, accident specifics, and, if necessary, credit card authorization for the processing fee, with clear instructions to offer as much information as possible for a successful search. A non-refundable search fee is required, payable to the New York State Thruway Authority, which can be processed through different payment methods including check, money order, and credit card. The form further outlines various delivery methods for the report, accommodates for processing time expectations, and specifies additional charges for returned checks. It emphasizes compliance with the New York State Public Authorities Law and tax laws, ensuring that the collected personal and payment information is securely managed and disclosed only to authorized entities for payment processing, unless legally mandated otherwise. Clearly, the completion and submission of this form are vital steps in accessing essential documentation following accidents on the Thruway System, making it a key component of post-accident procedures.

QuestionAnswer
Form NameForm Ta W4310
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesPDF, stolen vehicle report form, report stolen car, Requester

Form Preview Example

TA-W4310 (05/2014)

REQUEST FOR COPY OF POLICE ACCIDENT REPORT

New York State Thruway Authority

Attn: Office of Traffic Management

P.O. Box 189

Albany, NY 12201-0189

Fax No.: (518) 449-3198

Purpose: This Request is completed for accidents that occurred on the New York State Thruway System only.

INSTRUCTIONS:

•Complete Sections I, II and III (if applicable). Provide as much information as possible.

•A non-refundable $15.00 search fee payable to "New York State Thruway Authority" by check, money order (U.S. Currency) or credit card is required to process your Request.

•Send completed Request and search fee to the above address, fax number, or via email to accidentreport@thruway.ny.gov. (Requests sent by fax or email require fee to be paid by credit card. This form must be signed below to process credit card.)

NOTES:

-Reports may not be available for 30 days. Please allow 4 weeks for processing.

-There is a $25.00 returned check fee.

-For questions regarding the status of the copy of your Accident Report, please call (518) 471-4450.

Section I Requester Information

Name

Date of Request

Address (Street No./P.O. Box, City, State, Zip Code)

Daytime Phone No.

( ) -

Report should be sent to me by (choose one):

Mail - Provide address Report should be sent to (if different than above). Address:

Fax

 

 

Fax No.: (

)

-

E-mail - Reports sent via e-mail are in .PDF format. Adobe Acrobat Reader is necessary to view this document.

E-mail address:

Section II Accident Information (for accidents that occurred on the Thruway System only)

Police Report Complaint No.

Name of Driver(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Accident

 

 

 

 

 

 

Time of Accident

 

 

 

 

AM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thruway Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Milepost No.

 

 

 

 

Direction (North,

 

Service Area or Interchange

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

South, East, West)

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section III

Credit Card Authorization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

American Express

 

 

 

 

 

Discover

 

 

MasterCard

 

 

 

Visa

 

 

Card No.

 

 

-

 

 

-

 

 

-

 

 

 

 

 

 

 

Expiration Date

 

 

/

 

 

 

 

 

 

Cardholder Name (Print)

 

 

 

 

 

 

 

 

 

 

 

I hereby authorize the New York State Thruway

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Authority to charge a $15.00 (non-refundable) search

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fee to my credit card account.

 

 

 

 

 

 

 

Daytime Phone No. (

)

-

 

 

 

 

 

 

 

 

Cardholder Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notification Required Under Personal Privacy Protection Law

The information you are providing on this form is being requested pursuant to New York State Public Authorities Law as well as the New York State tax laws for credit card payment for goods or services received from the New York State Thruway Authority. This information will be provided only to the designated financial institution(s) and/or their agent(s) for the purpose of processing payments unless otherwise required by law to be released.

The information you are providing on this form is being requested pursuant to New York State Public Authorities Law as well as the New York State tax laws for credit card payment for goods or services received from the New York State Thruway Authority. This information will be provided only to the designated financial institution(s) and/or their agent(s) for the purpose of processing payments unless otherwise required by law to be released.

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