20190525 kannegiesser-deverneyON MAY 25, 2019, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT
APPROXIMATELY 15:26 I WAS ADVISED BY DISPATCH TO RESPOND TO HATCHERY ROAD AT THE FISH HATCHERY PARK FOR A REPORT OF A TWO
VEHICLE ACCIDENT. DISPATCH ADVISED THAT THERE WERE NO INJURIES, BUT THAT PEOPLE WERE ARGUING. I WENT EN ROUTE AND ARRIVED
ON SCENE AT 15:29. UPON ARRIVAL I MET WITH A MALE SUBJECT WHO IDENTIFIED HIMSELF AS . HE STATED THAT HIS
VEHICLE WAS ONE THAT WAS INVOLVED ALONG WITH A FEMALE SUBJECT WHO IDENTIFIED HERSELF AS . I RAN THE
LICENSE PLATES FOR BOTH VEHICLES WHO CAME BACK TO BOTH OF THOSE SUBJECTS. I ASKED DISPATCH TO RUN THE REGISTERED OWNERS
OF THE VEHICLES AND ADVISED THAT THEY WERE MY DRIVERS. I ASKED TO TELL ME WHAT HAPPENED. SHE STATED SHE WAS BACKING
OUT OF HER PARKING SPOT AND AS SHE DID S DID THE SAME THING AND THEY DID NOT SEE EACH OTHER AND HIT. SHE STATED SHE WAS
WEARING HER SEATBELT AND WAS THE ONLY PERSON IN THE VEHICLE. ALSO PROVIDED ME WITH HER INSURANCE CARD WHICH WAS
THROUGH STATE FARM INSURANCE AND ADVISED ME THAT SHE LOOKED OVER HER VEHICLE AND DID NOT NOTICE ANY DAMAGE. SHE STATED
SHE HAD A MARK ON HER CAR FROM BEFORE, BUT THAT WAS NOT FROM THIS INCIDENT. I WENT AND SPOKE TO AND ASKED HIM WHAT
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
PRIVATE PROPERTY/PARKING LOTReportable
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
03:26 PM
Date Notified
05/25/2019
Time Arrived
03:29 PM
Date Arrived
05/25/2019
Crash Time
03:25 PM
Crash Date
05/25/2019
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL13W8HLDAdditional InformationPHOTOS
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Crash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
HAD HAPPENED. HE ADVISED OF THE SAME THING AND STATED THEY DID NOT SEE EACH OTHER. HE STATED HIS WIFE WAS ALSO IN
THE VEHICLE WITH HIM AND THAT THEY WERE BOTH WEARING THEIR SEATBELTS. PROVIDED ME WITH HIS INSURANCE CARD WHICH
WAS THROUGH GEICO INSURANCE AND ADVISED ME THAT HE HAD A MINOR SCRATCH ON THE DRIVER SIDE OF THE REAR OF HIS VEHICLE. I
LOOKED AT THE SCRATCH AND TOOK PICTURES OF IT WHICH WILL BE ATTACHED TO MY REPORT. I ADVISED TO CALL HIS INSURANCE
COMPANY TO ADVISE THEM OF WHAT HAPPENED AND THEY WOULD ASSIST HIM WITH GETTING IT FIXED. I PROVIDED BOTH SUBJECTS WITH MY
BUSINESS CARD. SEE REPORT FOR MORE.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5105954.5
X Coordinate
157017.46875
Longitude
-91.431295369
Latitude
46.021180709
ON HATCHERY RD
0.67 MI N
OF STH77 EB
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
NON TRAFFICWAY - PARKING LOT
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
04--REAR TO REAR
First Harmful Event Location
OFF ROADWAY, LOCATION UNKNOWN
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
LEVEL
Road Curvature
STRAIGHT
Surface Type
SLAG, GRAVEL, OR STONE
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
N/A
Pre 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
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITModel
PACIFICA
Year
2006
Make
CHRYSLER
Vehicle Identification Number
75330101 Country of Issuance
UNITED STATES
St
WI
Plate Type
DIS - DISABLED
License Plate Number
Vehicle
Crash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name01Driver DistractionsNOT DISTRACTED
01Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
Extent Of Damage
NO DAMAGE
Vehicle Damage
NO DAMAGE
Initial Contact Point
6--REAR
Bus Use
NOT A BUS
Body Style
UT - SPORT UTILITY VEHICLE
Color
DBL - BLUE, DARK
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UNITHelmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
04/07/
Sex
FEMALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00101Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
UNIT Non Motorist
INDIVIDUALTruck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
Surface Type
SLAG, GRAVEL, OR STONE
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
N/A
Pre 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
2
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITModel
RAV4
Year
2017
Make
TOYOTA
Vehicle Identification Number
2T3RFREV7HW5565370202 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
945VNV
Vehicle
Crash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
DULUTH, MN 55802 , US
Owner Name02Driver DistractionsNOT DISTRACTED
02Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
7--LEFT REAR CORNER
Initial Contact Point
7--LEFT REAR CORNER
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
SIL - SILVER (ALUMINUM)VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
GEICO-CASUALTY-CO
Policy Holder
UNITHelmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: MINNESOTA COUNTRY: UNITED STATES
Address
DULUTH, MN 55802 , US
Race
WHITE
Date of Birth
04/06/
Sex
MALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00202Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00202 Tint ComplianceEye Protection
UNIT Non Motorist
INDIVIDUALInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00302 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
DULUTH, MN 55802 , US
Race
WHITE
Date of Birth
11/20/
Sex
FEMALE
Citations Issued
0
Passenger
ITEquipment
Individual
UNINDIVIDUALCrash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
19052532
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HLD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00302Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UNIT Non Motorist
INDIVIDUALCrash Time 03:25 PM
Crash Date 05/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.