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Citizen Incident Report

  1. This report is to be used by any citizen involved in a vehicle accident or incident occurring on municipal property which may or may not have required first-aid or hospital treatment, or resulted in the citizen complaining of discomfort or damage to private property as a result of the incident.

  2. * indicates required field

  3. Please further identify time of incident:*

  4. Was First-Aid Given?*

  5. Was Medical Emergency Treatment Given?*

  6. Please sign and date below.

  7. Please return the completed form by clicking either Submit or Submit and Print below, or by mailing to:

    Village of Lombard
    ATTN: Village Manager's Office
    255 E. Wilson Ave.
    Lombard, IL 60148.

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  9. This field is not part of the form submission.