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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.