Incident Form

22Apr

Cancelled Planning Board Meeting

22 Apr, 2020 PM 7:00 — 22 Apr, 2020 PM 8:00

Time

22 Apr, 2020 PM 7:00 — 22 Apr, 2020 PM 8:00

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21Apr

Town Board Meeting 7:30 PM

21 Apr, 2020 — 21 Apr, 2020

Time

21 Apr, 2020 — 21 Apr, 2020

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14Apr

Cancelled Town Hall Work Session 7:30 PM

14 Apr, 2020 — 14 Apr, 2020

Time

14 Apr, 2020 — 14 Apr, 2020

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07Apr

Town Board Meeting 7:30 PM

07 Apr, 2020 — 07 Apr, 2020

Time

07 Apr, 2020 — 07 Apr, 2020

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01Apr

Planning Board Technical Work Session by appointment

01 Apr, 2020 PM 3:00 — 01 Apr, 2020 PM 3:00

Time

01 Apr, 2020 PM 3:00 — 01 Apr, 2020 PM 3:00

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Town of Blooming Grove Incident Form

The Town Clerk's Office will submit this form to the Town's Insurance Company. Processing this form is not an acknowledgement of fault or liability, those determinations are made by the Town's Insurance Company.

Date
Month - Day - Year
Name of Person Completing Form / Title

First Name
Last Name
Date of Incident
Month - Day - Year
Authority Contacted
Location of Incident
Description of Incident
Description of Injury/Property Damage
Injured/Owner

Address

Street Address
Street Address 2
City	Region
Postal Code	Country

Home Phone
Area CodePhone Number
Business Phone
Area CodePhone Number
Estimate of Damages
Witnesses (Name/Address/Phone)
Miscellaneous Information/Remarks
Captcha

Cancelled Planning Board Meeting

Time

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Town Board Meeting 7:30 PM

Time

${DataItem.Address.Title}

Cancelled Town Hall Work Session 7:30 PM

Time

${DataItem.Address.Title}

Town Board Meeting 7:30 PM

Time

${DataItem.Address.Title}

Planning Board Technical Work Session by appointment

Time

${DataItem.Address.Title}

Town of Blooming Grove Incident Form