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GAS DRIVE FORM Brown County Sheriffs OfficeINSTRUCTIONS FOR STATION EMPLOYEES Was this GasDriveOff an intentional Criminal Act? No Credit Card swipe attempted on properly working Credit Card reader

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How to fill out gas drive-off incident form

01

Gather all necessary information: You will need the date and time of the incident, the location and name of the gas station, a description of the vehicle involved, the license plate number, and any additional details about the incident.

02

Fill out the top section of the form: Provide your personal information, such as your name, address, contact number, and driver's license information.

03

Provide details about the incident: Write a detailed account of what happened, including how the drive-off occurred, any witnesses present, and any other relevant information.

04

Attach any supporting evidence: If you have any photographs or videos of the incident, make sure to securely attach them to the form.

05

Sign and date the form: Once you have completed all the necessary sections, sign and date the form to certify the accuracy of the information provided.

06

Submit the form: Return the filled-out form to the appropriate authority, which may be the gas station management, local law enforcement, or insurance provider.

Who needs gas drive-off incident form?

01

Gas stations that have experienced a drive-off incident require the gas drive-off incident form. This form is used to document the incident, gather information about the offender's vehicle and behavior, and potentially pursue legal action or insurance claims.

02

Additionally, law enforcement agencies may also need the gas drive-off incident form to investigate the incident and potentially locate the individual responsible for the drive-off.

03

Insurance companies may also require this form as part of their claims process, especially if the gas station is seeking compensation for the stolen fuel.

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What is gas drive-off incident form?

The gas drive-off incident form is a document used to report incidents where a vehicle leaves a gas station without paying for fuel.

Who is required to file gas drive-off incident form?

Gas station owners or operators are typically required to file the gas drive-off incident form when such an incident occurs.

How to fill out gas drive-off incident form?

To fill out the gas drive-off incident form, provide details such as the date and time of the incident, vehicle description, license plate number, and the estimated cost of fuel taken.

What is the purpose of gas drive-off incident form?

The purpose of the gas drive-off incident form is to formally document incidents of fuel theft for insurance purposes and to assist law enforcement in investigating the theft.

What information must be reported on gas drive-off incident form?

Information that must be reported includes the location of the gas station, date and time of the incident, vehicle make and model, license plate number, and total amount of fuel stolen.

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