*** VOID IF NOT SIGNED ***
NOTE: Only reports that have been properly completed for all drivers and vehicles, and include the required attachments, will be
accepted, and processed. Any SR-1 report that is incomplete or does not meet the requirements of NRS 484E.070, as
specified above, will not be retained by the Department.
SR-1 (2/2023) Page 2 of 2
INSURANCE INFORMATION:
A COPY OF YOUR INSURANCE CARD MUST BE ATTACHED TO THIS REPORT.
Please ensure to attach a copy of your insurance card that was in effect on the date of the crash for the
vehicle involved. This information is necessary to verify that the vehicle was insured at the time of the crash. If
insurance was not in effect on the date of the crash, your driving privilege and registration may be suspended under
Chapter 485 of Nevada Revised Statutes.
CRASH DESCRIPTION:
Please write a brief description of the crash:
PROPERTY DAMAGE (other than the vehicle):
If you answer “Yes” below, please explain in the space provided:
☐
Was there damage to property other than the vehicle? If Yes, describe:
Property Owner’s Address:
ESTIMATE OF REPAIRS:
AN ESTIMATE OF REPAIRS OR A STATEMENT OF TOTAL LOSS MUST BE ATTACHED if there was $750 or
more in vehicle or property damage (of any one person). Pursuant to NRS 484E.070, the estimate of repairs or
statement of total loss must be from an established repair garage, an insurance adjuster employed by an insurer
licensed to do business in the State of Nevada, an adjuster licensed pursuant to Chapter 684A of NRS, or an
appraiser licensed pursuant to Chapter 684B of NRS.
This SR-1 report will be considered VOID if not attached.
PERSONAL INJURY:
If an injury occurred, A DOCTOR’S STATEMENT OF INJURY OF EACH INDIVIDUAL INJURED IN YOUR
VEHICLE MUST BE ATTACHED.
VOID if not attached!
Driver
Passenger
Relationship to Driver of Your Vehicle*
*Husband, wife, son, daughter, etc.
Nature and Extent of Injuries
SIGNATURE:
By completing this report, you are authorizing the Department of Motor Vehicles to release your name,
mailing address, and insurance information to the other parties involved in the traffic crash and/or to their
insurer (NRS 484E.070).
I hereby certify all statements made in this report are true. I agree and understand any person who
completes this report know
ing or having reason to believe the information is false is guilty of a gross
misdemeanor. (NRS 484E.080)