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Duke incapacitation form

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Name of Reporting Railroad 2. Alphabetic Code 3. Report Month Year 9. Telephone 5. County 7. Official Title 8. Address OMB No* 2130-0500 4. State Alphabetic Code Area Code Number If executed within the United States its territories possessions or commonwealths I declare or certify verify or state under penalty of perjury that the foregoing is true and correct. Executed on date. Signature. OPERATIONAL DATA ACCIDENT/INCIDENT COUNTS FOR REPORT MONTH 12. Passenger Train Miles 11. Freight Train Mile ...

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