20190721 momchilovich19072109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GFB001 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
NON-DOMESTICATED ANIMAL W/ NO INJURYReportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
05:26 AM
Date Notified
07/21/2019
Time ArrivedDate ArrivedCrash Time
05:26 AM
Crash Date
07/21/2019
Investigating Officer/Deputy
DEPUTY RYAN SCHICK
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GFB001I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
NO STRUCTURE
Y CoordinateX Coordinate
LongitudeLatitudeON STH27 WB
1.00 MI E
OF COUNTY HIGHWAY CC
IN THE TOWN OF COUDERAY
IN SAWYER COUNTY
Location
Special StudyAccess ControlTribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
DEER
Weather Condition(s)
Environment Factor(s)
Roadway Factor(s)Road Surface Condition(s)
Light ConditionManner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Road GradeRoad CurvatureSurface Type
Traffic Control Inoperative/MissingTraffic ControlTraffic Way
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCrash Time 05:26 AM
Crash Date 07/21/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
19072109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GFB001 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Truck Bus or HazMat
NO
Owner AddressOwner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle FactorsWhat Driver Was Doing
Vehicle Removed By
OPERATOR
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER,
12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
GRY - GRAY
Model
EQUINOX
Year
2018
Make
CHEVROLET
Vehicle Identification Number
97040101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLEInjury
Distracted By Distracted By Source
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/ExtricatedEjection PathEjected
AirbagInjury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
LADYSMITH, WI 54848 , US
Race
WHITE
Date of Birth
09/15/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 05:26 AM
Crash Date 07/21/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
19072109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GFB001 WISCONSIN MOTOR VEHICLE
CRASH REPORT
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
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #
Distracted By Action
Non Motorist
UNITINDIVIDUALCrash Time 05:26 AM
Crash Date 07/21/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.