200112 martin-stowe20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX 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
02
Total Units
02
Time Notified
10:00 AM
Date Notified
01/12/2020
Time Arrived
10:24 AM
Date Arrived
01/12/2020
Crash Time
09:57 AM
Crash Date
01/12/2020
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GMH5JXAdditional 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 12TH, 2020, I, DEPUTY REED RESPONDED TO A HIT AND RUN ACCIDENT IN WHICH A VEHICLE BEING OPERATED BY
REAR ENDED A VEHICLE BEING OPERATED BY DROVE AWAY FROM THE SCENE WITHOUT STOPPING.
AND HER PASSENGER, BOTH WENT ROUTINE TO THE HOSPITAL FOR POSSIBLE WHIP LASH NECK INJURIES.
VEHICLE DID HAVE AT LEAST $1000 DAMAGE TO IT. A WITNESS TO THE ACCIDENT, FOLLOWED TO A NEARBY CHURCH
THEN RETURNED TO THE SCENE TO INFORM OF THE LOCATION OF VEHICLE SO COULD INFORM LAW
ENFORCEMENT. WAS MAILED A CITATION FOR OWNER LIABILITY FOR FAILURE TO STOP AFTER ACCIDENT, A CITATION FOR HIT AND
RUN PROPERTY DAMAGE, A REPORT WILL BE FORWARDED TO THE DISTRICT ATTORNEY'S OFFICE FOR HIT AND RUN PROPERTY DAMAGE CHARGE
CONSIDERATIONS AND I COMPLETED A DRIVER CONDITION REPORT ON .
Crash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5068993
X Coordinate
160125.296875
Longitude
-91.365179921
Latitude
45.691027364
ON CTHC SB
552 FT N
OF STH48 EB
IN THE TOWN OF METEOR
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
TRAFFICWAY - ON ROAD
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
02--FRONT TO REAR
First Harmful Event Location
ON ROADWAY
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
TWO-WAY, NOT DIVIDED
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
55
Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
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
UNITExtent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
6--REAR
Initial Contact Point
6--REAR
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
GRY - GRAY
Model
IMPALA
Year
2011
Make
CHEVROLET
Vehicle Identification Number
26030101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
OJIBWA, WI 54862 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
SLOW/STOPPING
Vehicle Removed ByTowed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH IN TRANSPORT02
Event
03Event
04Individual
Insurance Company
AMERICAN-FAMILY-INS-CO
Policy Holder
UNITInjury
Distracted By
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
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
POSSIBLE 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
OJIBWA, WI 54862 , US
Race
WHITE
Date of Birth
07/29/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX 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 #Non Motorist
UNITINDIVIDUALInjury
Distracted By
LocationStriking Unit #
Distracted By Action
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
POSSIBLE 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
OJIBWA, WI 54862 , US
Race
WHITE
Date of Birth
12/06/
Sex
MALE
Citations Issued
0
Passenger
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX 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
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
TWO-WAY, NOT DIVIDED
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
55
Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER VAN02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
HIT AND RUN
Unit Summary
UNITVehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
TAN - TAN
Model
TC
Year
2003
Make
CHRYSLER
Vehicle Identification Number
09200202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BIRCHWOOD, WI 54817 , US
Owner Name
0202Driver Actions
OTHER CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH IN TRANSPORT02
Event
03Event
04Injury
Distracted By
Prior Action
LocationStriking Unit #
Distracted By Action
Distracted By Source
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT APPLICABLE
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT APPLICABLE
Airbag
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00302 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BIRCHWOOD, WI 54817 , US
Race
WHITE
Date of Birth
02/16/
Sex
FEMALE
Citations Issued
2
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
20011209
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JX 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 UseSuspected Alcohol Use
To/From SchoolAction Other
Action
UNITINDIVIDUAL Violations
DescriptionVEHICLE OWNER'S LIABILITY FOR FSA - ATTENDED VEHICLEStatute Number346.675(1)Issue To?
003
UTC Number
BE64942803
DescriptionHIT AND RUNStatute Number346.67(1)Issue To?
003
UTC Number
BE64942904
Crash Time 09:57 AM
Crash Date 01/12/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.