A Sworn Statement for Traffic Crash Report Information plays a crucial role in the aftermath of a vehicle accident, particularly in the state of Florida. This document is essential for individuals or entities seeking access to crash report information, which is confidential and guarded under the law for a period of 60 days post-report filing. The form sets a clear boundary around the dissemination and use of the information, emphasizing the repercussions of unauthorized access—a felony violation. It intricately details the qualifications needed for immediate disclosure of the crash report, ranging from personal involvement in the crash to legal representation, insurance-related needs, prosecutorial purposes, media reporting, governmental function, or victim service provision. The completion of this form requires the applicant to affirm the legitimacy of their request and pledge not to use the information for commercial solicitation of accident victims. Moreover, it delineates the verification process carried out by a notary public or a certified law enforcement or correctional officer, ensuring the authenticity of the declaration. With spaces allocated for all necessary details, including identification of the requester and the specific crash report sought, this sworn statement underscores the balance between the public's right to information and the privacy rights of individuals involved in traffic accidents.
| Question | Answer |
|---|---|
| Form Name | Sworn Statement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | sworn financial statement form jcf 1111sc r1 18, sworn statement template for michigan, sworn statement for traffic crash report information, blank sworn statement |
SWORN STATEMENT FOR TRAFFIC CRASH REPORT INFORMATION
Motor vehicle crash information is confidential and exempt from disclosure for a period of 60 days after the date the crash report is filed. §316.066(3)(c) Fla. Stats. (2003). Obtaining confidential information by someone who knows they are not entitled to do so is a felony violation.
The undersigned requests the following crash report (date/location/parties):
____________________________________________________________________________.
The undersigned states that he/she or the organization they represent qualify for immediate disclosure of the crash report according to the exemption checked below and does swear or affirm that information contained in a crash report made confidential by statute will not be used for any commercial solicitation of accident victims, or knowingly disclosed to any third party for the purpose of such solicitation, during the period of time that the information remains confidential.
I am a party involved in the crash.
I am a legal representative to a party involved in the crash: Fla. Bar No _________,
OR Immediate Relative (relation) ______________
OR Written Authority from immediate relative, copy attached.
I am a licensed insurance agent to a party involved in the crash, their insurer or insurers to which they applied for insurance coverage, Fla. License No. __________
I am a person under contract to provide claims or underwriting information to a qualifying insurance company, identified as: _________________________________
I am a prosecuting authority, Fla. Bar No. __________________________________
I represent a radio or television station licensed by the FCC or newspaper qualified to publish legal notices or a free newspaper of general circulation, which qualifies under the statute ________________________________________________________
Name of Radio/Television Station, Newspaper
I represent a local, state or federal agency that is authorized by law to have access to these reports.
I represent a Victim Service Program, as defined in §316.003(84), Florida Statutes. Name of Program: _______________________________________________________
__________________________________ |
___________________________________ |
Printed Name |
Agency/Business Represented |
__________________________________ |
____________________________________ |
Signature |
Address |
____________________________________ |
____________________________________ |
(Area Code) Telephone Number |
City, State, Zip Code |
State of Florida, County of _____________
Sworn to (or affirmed) and subscribed before me this ____ day of ____________, 200__, by
Personally known____ or Produced Identification____ Type of i.d. produced:_________________
______________________________ |
___________________________________ |
Print, Type, or Stamp, Commissioned name of Notary |
Signature of Notary Public or Certified Law Enforcement or |
|
Correctional Officer |
Drivers license or other photographic identification, proof of status or identification that demonstrates qualifications to access this information were reviewed by
_________________________________________________, agency employee, on this ____
day of __________, 200__.