20190809 beaudin-schulerON AUGUST 9, 2019, I, DEPUTY AMBER AL-MOGHRABI, WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT
APPROXIMATELY 14:58, I WAS ADVISED BY DISPATCH TO RESPOND TO KWIK TRIP IN HAYWARD FOR A REPORT OF A 2 VEHICLE ACCIDENT. UPON
ARRIVAL AT 15:01, I WAS MET BY WHO STATED HER DAUGHTER WAS IN A CAR ACCIDENT WHILE TRYING TO LEAVE THE
PARKING LOT. I ADVISED DISPATCH THAT I HAD A WI REGISTRATION FOR HIM TO RUN. THEY ADVISED THAT THEY HAD ALREADY RUN BOTH
VEHICLES WHICH CAME BACK CURRENT AND CLEAR. DISPATCH ADVISED THAT HE ALSO RAN BOTH DRIVERS WHO AGAIN CAME BACK CLEAR AND
VALID. I ASKED IF I COULD TALK TO HER DAUGHTER, , WHO WAS THE DRIVER OF THE SEDAN. STATED
THAT HER AND HER BROTHER WERE IN THE VEHICLE PARKED AT THE ENTRANCE ON STATE HWY 27. SHE SAID THEY WERE STOPPED WHILE
WAITING FOR TRAFFIC TO SLOW DOWN SO THEY COULD TURN ON TO STATE HWY 27. SHE SAID AT THAT TIME A WHITE TRUCK STARTED TO BACK
OUT OF THEIR PARKING SPOT AND HIT HER VEHICLE. I ASKED WHERE THAT VEHICLE WENT. SHE SAID THAT THE MALE DRIVER GOT
OUT OF HIS TRUCK AND CAME UP TO TALK TO HER. SHE SAID THAT HE GAVE HER HIS INSURANCE CARD TO TAKE A PICTURE OF AND PROVIDED
HIS TELEPHONE NUMBER AND SAID THERE WAS NO DAMAGE TO HIS VEHICLE AND LEFT. SHE STATED THAT HE SAID HE DID NOT SEE HER
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL 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
02:58 PM
Date Notified
08/09/2019
Time Arrived
03:01 PM
Date Arrived
08/09/2019
Crash Time
02:55 PM
Crash Date
08/09/2019
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FZQKRLAdditional 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 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
VEHICLE PARKED THERE. SAID THAT SHE CALLED HER MOTHER THEN BECAUSE SHE WASN'T SURE WHAT SHE SHOULD DO. I LOOKED
AT THE DAMAGE TO R CAR AND NOTICED A CRACK TO THE PASSENGER SIDE REAR BUMPER ALONG WITH DENTS AND SCRATCHES. I
TOOK PICTURES OF THE DAMAGE AND ATTACHED THEM TO MY REPORT IN SPILLMAN. I ASKED IF HER OR HER BROTHER WERE
INJURED. SHE STATED THEY WERE NOT AND WERE BOTH WEARING THEIR SEAT BELTS. I THEN GOT HER BROTHER'S INFORMATION, WHO HAD
LEFT THE SCENE WITH HIS FATHER, AS HE WAS THE PASSENGER IN THAT VEHICLE. SEE REPORT FOR MORE DETAILS.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5105265.5
X Coordinate
152849.78125
Longitude
-91.48447457
Latitude
46.012901144
ON STH27 NB
59 FT S
OF USH63 NB
IN THE CITY OF HAYWARD
IN 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 - 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
07--REAR TO SIDE
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
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
0
Speed Limit
05
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
2
Operating As EndorsementsVehicle Type
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITBus Use
NOT A BUS
Body Style
SD - SEDAN
Color
GRY - GRAY
Model
ION
Year
2004
Make
SATURN
Vehicle Identification Number
8520101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
STOPPED IN PARKING LOT WAITING TO LEAV
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
OTHER
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
3--RIGHT SIDE MIDDLE, 4--RIGHT SIDE REAR, 5--RIGHT REAR CORNER
Initial Contact Point
4--RIGHT SIDE REAR
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
INTEGRITY-MUTUAL-INS-CO
Policy Holder
UNITInjury
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet 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
INDIAN
Date of Birth
09/11/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Distracted By
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
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Non Motorist
UNITINDIVIDUALInjury
Distracted By Distracted By Source
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00201 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 Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BLK RIVER FALLS, WI 54615 , US
Race
INDIAN
Date of Birth
09/08/
Sex
MALE
Citations Issued
0
Passenger
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00201Drug 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
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #
Distracted By Action
Non Motorist
UNITINDIVIDUALTruck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
0
Speed Limit
05
Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
NO DAMAGE
Vehicle Damage
NO DAMAGE
Initial Contact Point
6--REAR
Bus Use
NOT A BUS
Body Style
PK - PICKUP
Color
WHI - WHITE
Model
F150 XLT
Year
2013
Make
FORD
Vehicle Identification Number
51380202 Country of Issuance
UNITED STATES
St
MN
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
UNITVEHICLECrash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
CHISAGO CITY, MN 55013 , US
Owner Name
0202Driver Actions
UNSAFE BACKING
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
SAFECO-INS-CO-OF-AMERICA
Policy Holder
UNITInjury
Distracted By
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00302 Tint ComplianceEye Protection
Helmet 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
CHISAGO CITY, MN 55013 , US
Race
WHITE
Date of Birth
02/12/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
19080931
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
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
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #Non Motorist
UNITINDIVIDUALCrash Time 02:55 PM
Crash Date 08/09/2019Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.