20160731 EwerAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Repor able Accident On Emergency Amended GZDHL6J
DOT Document Number Document Override Number
16080405
16
0
8
0
4
0
5
07/31/2016
4 - Accident Date
1600
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County DRAPER - 03, TOWN3 - Municipality PRIVATE PROPERTY11 - Accident Location
14 - On Hwy No.
PRIVATE PROPERTY
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.LUDS LN16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
3694
17 - Structure Number
45.885158
12 - Latitude -90.86347313 - Longitude
OTHER FIXED OBJECT80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control 113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
SLAG, GRAVEL, OR STONE - 4
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition UNKNOWN116 - Road Surface Condition UNKNOWN118 - Weather
Hit and Run
9
Government Property
9
Fire
9
Photos Taken
9
Trailer or Towed
9
Truck, Bus, or Hazardous Materials
9
Load Spillage
9
Construction Zone
9
Names Exchanged
9
Supplemental Reports
101
Witness Statements
102
Measurements Taken
103 79 - E M S Number
Operator/Pedestrian
OP
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
OTHER FIXED OBJECT
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
0524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2013
31 - Expiration Year 34 - On Duty Accident
EWER
25 - Operator/Pedestrian Last Name
SARAH
25 - First Name
NICHOLE
25 - Middle Initial 25 - Suffix
07/03
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
MEDFORD
27 - City
WI
27 - State
54451-1380
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
RESTRAINT-USE-UNKNOWN
40 - Safety Equipment
N - NO APPARENT INJURY
38 - Injury Severity
UNKNOWN
41 - Airbag
UNKNOWN
42 - Ejected 44
Medical Transport
UNKNOWN
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
NOT OBSERVED88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6J 1 4
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
925PHZ
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
1G1ZT61886F28
55 - Vehicle Identification Number
2006
50 - Year
CHEV
51 - Make
MALIBU
52 - Model
4D - 4DR
53 - Body Style
DBL
54 - Color 100 - Skidmarks to Impact (Ft)
UNKNOWN
94 - Vehicle Damage
UNKNOWN
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
EWER
46 - Vehicle Owner Last Name
SARAH
46 - First Name
NICHOLE
46 - Middle Initial 46 - Suffix
07/03 0
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MEDFORD48 - City WI48 - State 54451-138048 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6J 2 424
Fixed Objects Struck
PR
O
P
E
R
T
Y
O
W
N
E
R
Property
INDIVIDUAL
Organization Type
CAIN
84 - Property Owner Last Name
DAVID
84 - First Name
REED
84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
LORETTA
86 - City
WI
86 - State
54896
86 - Zip Code
.
87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
OTHER-FIXED-OBJECT
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
N. RASCHKA
ON AUGUST 4, 2016 I, DEPUTY RASCHKA RECEIVED A CALL FROM A DAVID AND SUZANNE CAIN REFERENCE AN INCIDENT THAT
OCCURRED ON JULY 31, 2016 IN WHICH A VEHICLE PULLED INTO THE PARKING LOT OF THEIR BAR: NORTH COUNTRY INN AT 3694N
STATE HWY 70 AND STRUCK THE SOUTHWEST CORNER OF THE DECK ATTACHED TO THE BAR. THE CAIN'S ADVISED THEY HEARD
WHAT SOUNDED LIKE A CRASH BETWEEN 4PM AND 5PM ON SUNDAY EVENING, WHEN MRS CAIN WENT TO SEE WHAT HAD
HAPPENED, SHE OBSERVED A DARK COLORED SEDAN PULL QUICKLY OUT OF THE DRIVEWAY AND PROCEED EASTBOUND ON
STATE HWY 70. I ASKED IF ANYONE EVER CAME OUT OF THE VEHICLE AND SPOKE TO THEM, SHE STATED THAT NO ONE DID. MRS CAIN STATED LATER THAT DAY, HER HUSBAND WALKED AROUND THE DECK TO CHECK THE EXTENT OF THE DAMAGE AND
NOTICED THAT A LICENSE PLATE WAS SITTING ON THE GROUND NEXT TO THE DECK WHERE IT WAS STRUCK. I COLLECTED THE
LICENSE PLATE. SAWYER COUNTY DISPATCH ADVISED THAT THE REGISTRATION BELONGED TO A SARAH EWER FROM MEDFORD,
WI. I NOTED THAT THE DECK WAS PAINTED RED AND THERE APPEARED TO BE RED PAIN TRANSFER ON THE LICENSE PLATE.
THERE WAS ALSO AN INDENT ON THE WOODEN PORTION OF THE DECK THAT MATCHED THE SIZE AND CHARACTER OF THE PLACE
HOLDER PIECE ON THE BLACK PLASTIC LICENSE PLATE HOLDER. I DOCUMENTED THE DAMAGE OF THE DECK AND NOTED THAT IT APPEARED TO HAVE BEEN SHIFTED FROM ITS ORIGINAL SITE APPROXIMATELY 3-5 INCHES. THERE WAS ALSO A CRACK IN ONE OF
THE SUPPORT BEAMS FROM THE ROOF AND THE DECK ITSELF APPEARED CROOKED. DUE TO THE NON-REPORTING OF THE
ACCIDENT, MS. EWER WILL BE CITED FOR OWNERS LIABILITY OF A HIT AND RUN ACCIDENT. END OF REPORT.
ON AUGUST 4, 2016 I, DEPUTY RASCHKA RECEIVED A CALL FROM A DAVID AND SUZANNE CAIN REFERENCE AN INCIDENT THAT
OCCURRED ON JULY 31, 2016 IN WHICH A VEHICLE PULLED INTO THE PARKING LOT OF THEIR BAR: NORTH COUNTRY INN AT 3694N
STATE HWY 70 AND STRUCK THE SOUTHWEST CORNER OF THE DECK ATTACHED TO THE BAR. THE CAIN'S ADVISED THEY HEARD
WHAT SOUNDED LIKE A CRASH BETWEEN 4PM AND 5PM ON SUNDAY EVENING, WHEN MRS CAIN WENT TO SEE WHAT HAD
HAPPENED, SHE OBSERVED A DARK COLORED SEDAN PULL QUICKLY OUT OF THE DRIVEWAY AND PROCEED EASTBOUND ON
STATE HWY 70. I ASKED IF ANYONE EVER CAME OUT OF THE VEHICLE AND SPOKE TO THEM, SHE STATED THAT NO ONE DID. MRS CAIN STATED LATER THAT DAY, HER HUSBAND WALKED AROUND THE DECK TO CHECK THE EXTENT OF THE DAMAGE AND
NOTICED THAT A LICENSE PLATE WAS SITTING ON THE GROUND NEXT TO THE DECK WHERE IT WAS STRUCK. I COLLECTED THE
LICENSE PLATE. SAWYER COUNTY DISPATCH ADVISED THAT THE REGISTRATION BELONGED TO A SARAH EWER FROM MEDFORD,
WI. I NOTED THAT THE DECK WAS PAINTED RED AND THERE APPEARED TO BE RED PAIN TRANSFER ON THE LICENSE PLATE.
THERE WAS ALSO AN INDENT ON THE WOODEN PORTION OF THE DECK THAT MATCHED THE SIZE AND CHARACTER OF THE PLACE
HOLDER PIECE ON THE BLACK PLASTIC LICENSE PLATE HOLDER. I DOCUMENTED THE DAMAGE OF THE DECK AND NOTED THAT IT APPEARED TO HAVE BEEN SHIFTED FROM ITS ORIGINAL SITE APPROXIMATELY 3-5 INCHES. THERE WAS ALSO A CRACK IN ONE OF
THE SUPPORT BEAMS FROM THE ROOF AND THE DECK ITSELF APPEARED CROOKED. DUE TO THE NON-REPORTING OF THE
ACCIDENT, MS. EWER WILL BE CITED FOR OWNERS LIABILITY OF A HIT AND RUN ACCIDENT. END OF REPORT.
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6J 3 4
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
Officer Information
RASCHKA
125 - Officer Last Name
NICOLE 388
131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
08/04/2016
132 - Date Notified 1555133 - Time Notified (Military Time)1646134 - Time Arrived (Military Time)
08/04/2016
135 - Date Of Report
16080405 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6J 4 4