20190103 STOLTZ.pdf19010305
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KZ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
02
Time Notified
04:07 PM
Date Notified
01/03/2019
Time Arrived
04:40 PM
Date Arrived
01/03/2019
Crash Time
12:00 PM
Crash Date
01/03/2019
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
3
J
5
5
K
Z
Additional InformationPHOTOS
Photos ByDEPUTY AMANDA REED #356
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON JANUARY 3RD, 2019, I, DEPUTY REED TOOK A REPORT OF A HIT AND RUN ACCIDENT. COMPLAINANT STATED SOMEONE HIT HER
PARKED VEHICLE AT HER PLACE OF EMPLOYMENT LOCATED IN WINTER WI. STATED SHE DID NOT KNOW WHO, DID NOT SEE INCIDENT
AND THERE ARE NO SURVEILLANCE CAMERAS THERE. I LATER MET AT HER HOME AND PHOTOGRAPHED THE DAMAGE TO HER VEHICLE. NO FURTHER INFORMATION AT THIS TIME.
Crash Time 12:00 PM
Crash Date 01/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
19010305
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KZ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
HOUSE/BUILDING
Y Coordinate
5082240
X Coordinate
188362.671875
Longitude
-91.011977508
Latitude
45.823239054
PARKING LOT
STROUF AVE LOT 6617W
(HOUSE/BUILDING 6617W)
IN THE TOWN OF WINTERIN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
PRIVATE PROPERTY
Crash Classification - Location
PRIVATE PROPERTY
Relation To Trafficway
NON TRAFFICWAY - OTHER
Animal Type
Weather Condition(s)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
05--SIDESWIPE/SAME DIRECTION
First Harmful Event Location
IN PARKING LANE OR ZONE
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
UNKNOWN
Road Curvature
UNKNOWN
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
0
Operating As EndorsementsVehicle Type
PASSENGER CAR01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
LEGALLY PARKED
Unit Summary
UN
IT
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
7--LEFT REAR CORNER, 8--LEFT SIDE REAR
Initial Contact Point
7--LEFT REAR CORNER
Bus UseNOT A BUSBody Style
2D - 2DR
Color
GRY - GRAY
Model
ALTIMA
Year
2008
Make
NISSAN
Vehicle Identification Number
63550101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 12:00 PM
Crash Date 01/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
19010305
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KZ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
RADISSON, WI 54867 , US
Owner Name
01
Driver Distractions
01
Driver Actions
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEGALLY PARKED
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventMOTOR VEH IN TRANSPORT01
EventPARKED MOTOR VEHICLE02
Event
03
Event
04
IndividualInsurance Company
INTEGRITY-MUTUAL-INS-CO
Policy Holder
UN
I
T
Truck Bus or HazMat
NO
Road Grade
UNKNOWN
Road Curvature
UNKNOWN
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
UNKNOWN
Special Function
UNKNOWNMost Harmful Event: Collision With
PARKED MOTOR VEHICLE
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
UNKNOWN
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR02
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
HIT AND RUN
Unit Summary
UN
IT
Country of IssuanceStPlate TypeLicense Plate Number
Vehicle
Crash Time 12:00 PM
Crash Date 01/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
19010305
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KZ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
, ,
Owner Name
02
Driver DistractionsUNKNOWN IF DISTRACTED
02
Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
UNKNOWN
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
UNKNOWN
Vehicle Damage
UNKNOWN
Initial Contact Point
UNKNOWN
Bus UseNOT A BUSBody StyleColor
ModelYearMakeVehicle Identification Number
0202
VE
H
I
C
L
E
UN
I
T
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventMOTOR VEH IN TRANSPORT01
EventPARKED MOTOR VEHICLE02
Event
03
Event
04
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 12:00 PM
Crash Date 01/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
19010305
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KZ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
NOT OBSERVED
Drug Type
00
1
02
Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug UseSuspected Alcohol Use
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT APPLICABLE
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT APPLICABLE
Airbag
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00
1
02
Tint ComplianceEye Protection
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 12:00 PM
Crash Date 01/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.