20110621 bates20110621
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKM 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
05:47 PM
Date Notified
11/06/2020
Time ArrivedDate ArrivedCrash Time
05:40 PM
Crash Date
11/06/2020
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
20110621
Primary Crash Document #Document Number Override
6VL0J3XHKMI, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
NO STRUCTURE
Y Coordinate
5087386
X Coordinate
152891.671875
Longitude
-91.470998605
Latitude
45.852490696
ON STH27 NB
279 FT S
OF ROBIN LN
IN THE TOWN OF SAND LAKE
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
00 - 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
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCrash Time 05:40 PM
Crash Date 11/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
20110621
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Truck Bus or HazMat
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
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
11 - LEFT FRONT CORNER
Initial Contact Point
11 - LEFT FRONT CORNER
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
WHI - WHITE
Model
CHEROKEE
Year
2015
Make
JEEP
Vehicle Identification Number
07970101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLEIndividual
Insurance Company
PROGRESSIVE-CASUALTY-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 PositionRow
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
STONE LAKE, WI 54876 , US
Race
WHITE
Date of Birth
01/07/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 05:40 PM
Crash Date 11/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
20110621
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
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
Distracted By Source
UNITNon Motorist
INDIVIDUALCrash Time 05:40 PM
Crash Date 11/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.