20191107 kempf19110704
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3J 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
08:32 AM
Date Notified
11/07/2019
Time ArrivedDate ArrivedCrash Time
08:28 AM
Crash Date
11/07/2019
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0JB3P3JI, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
Y Coordinate
5079200
X Coordinate
189695.359375
Longitude
-90.992909025
Latitude
45.796546932
ON CTHW SB
1091 FT E
OF EVERSON RD
IN THE TOWN OF WINTER
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
SOUTHBOUND
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 TRUCK01 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCrash Time 08:28 AM
Crash Date 11/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
19110704
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3J 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 ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
PK - PICKUP
Color
SIL - SILVER (ALUMINUM)
Model
SILVERADO
Year
2006
Make
CHEVROLET
Vehicle Identification Number
43660101 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLEIndividualInsurance Company
WESTERN-STATES-MUTUAL-INS-CO
Policy Holder
UNITInjury
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
AUBURNDALE, WI 54412 , US
Race
WHITE
Date of Birth
10/30/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 08:28 AM
Crash Date 11/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
19110704
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3J 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
Distracted By Source
Non Motorist
UNITINDIVIDUALCrash Time 08:28 AM
Crash Date 11/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.