Personal History Statement (Phs) Page 17
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24Akron Police Division
Personal History Statement (PHS)
59. Have you ever been involved in an accident where you left the scene without identifying yourself?
Yes
No If “Yes”,
please provide specifics.
(Continue this response on a separate page if necessary)
60. List all vehicles you own, possess and/or that are registered to you.
Year
Make Model
Color
License Number & State
Is the vehicle currently registered?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
61. Has your license ever been suspended, revoked, or canceled in any state?
Yes
No
If “Yes”, please give details including what, when, where, why.
(Continue this response on a separate page if necessary)
62. Have you ever been refused insurance for any reason other than failure to pay a premium?
Yes
No
If “Yes”, please explain including company name and address, date, and reason.
(Continue this response on a separate page if necessary)
Page 17 of 24
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