20170205 Kelsey17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
03:05 PM
Date Notified
02/05/2017
Time Arrived
03:26 PM
Date Arrived
02/05/2017
Crash Time
03:00 PM
Crash Date
02/05/2017
Investigating Officer/Deputy
DEP/DEPU AMBER ALMOGHRABI
Agency Crash Number
17020506
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
J
R
Additional InformationPhotos
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON FEB 5, 2017, I WAS DISPATCHED TO THE INTERSECTION OF BOEDECKER ROAD AND TELEMARK ROAD FOR A VEHICLE THAT HAD HIT A TREE. UPON ARRIVAL AT 15:26, I MET WITH STONE KELSEY WHO WAS IDENTIFIED BY HI WI DRIVER'S LICENSE, WHO STATED HE WAS TRAVELING
EASTBOUND ON BOEDECKER ROAD. HE STATED WHILE TRYING TO NEGOTIATE A CORNER HE STARTED TO SLID. STONE STATED HE ATTEMPTED
TO CORRECT THE VEHICLE AND SUCCEEDED. HE STATED THE VEHICLE WENT BACK INTO ITS LANE WHEN IT STARTED TO SLID AGAIN. STONE
STATED HE ATTEMPTED TO CORRECT THE VEHICLE AGAIN, WHEN THE BACK END STARTED TO SLID AND HE LOST CONTROL OF THE VEHICLE.
THAT IS WHEN STONE'S VEHICLE HIT THE TREE. ALONG WITH STONE IN THE VEHICLE WAS HIS BROTHER TANNER AND HIS COUSIN FREDERICK.
ALL THREE BOYS STATED THEY WERE WEARING THEIR SEATBELTS AND HAD NOT BEEN DRINKING. STONE STATED HE HAD AMERICAN FAMILY INSURANCE. I THEN WENT TO LOOK AT THE VEHICLE AND NOTICED THE FRONT HIT THE TREE ALMOST HEAD ON AND WAS TOTALED. AT THIS
TIME ROADRUNNER TOWING ARRIVED ON SCENE. I TOOK PICTURES OF THE DAMAGE TO THE VEHICLE AND PLACED THEM INTO EVIDENCE AS
ITEM NUMBER 1700090-0001. THE VEHICLE WAS REMOVED FROM THE SCENE. STONE INFORMED ME THAT WHEN THEY GOT AN ESTIMATE OF THE
DAMAGE HE WOULD LET ME KNOW WHAT IT WAS. I CLEARED THE CALL AT 15:49.
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of1
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5117582.5
X Coordinate
169217.65625
Longitude
-91.282203318
Latitude
46.131540249
ON SEELEY RD
348 FT E
OF SEELEY FIRE TOWER RD
IN THE TOWN OF SPIDER LAKE
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 - Not On Road
Animal Type
Weather Condition(s)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Snow
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
On Roadway
First Harmful Event
Tree
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Downhill
Road Curvature
Straight
Surface Type
Unknown
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Tree
Total Lanes
2
Speed Limit
45Pre CrashTire
Mark
Direction Of Travel
Eastbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
3
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 11--Left Front Corner, 12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
PK - PICKUP
Color
BLK - Black
Model
F150
Year
2000
Make
FORD
Vehicle Identification Number
8669
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
MN1942
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of2
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver Actions
Speed Too Fast/Cond
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualMARK S KELSEY01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventTree01
Event
02
Event
03
Event
04
Individual
MARK KELSEY
Insurance Company
AMERICAN-FAMILY-MUTUAL-INS-CO
Policy Holder
UN
I
T
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of3
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
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
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
1
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
09/12/ 7
Sex
Male
Citations Issued
0
DriverSTONE S T KELSEY
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of4
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
2
01
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
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--Front Seat-Right Side (Train Engineers/Right
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address E
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
10/26/
Sex
Male
Citations Issued
0
PassengerTANNER M KELSEY
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of5
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
3
01
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
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
6--Second Seat-Right Side
00
3
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
D berS
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
05/15/ 0
Sex
Male
Citations Issued
0
PassengerFREDERICK V STONE
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Address
, ,
Unknown
PR
O
P
OW
N
E
R
01
Property Owner
Fixed Objects Struck
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of6
Wisconsin Motor Vehicle Crash
Form DT4000
17020501425
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJR Wisconsin Motor Vehicle
Crash Report
Damage Tag NumberStruck Object
Tree
Striking Unit
0101
Crash Time 03:00 PM
Crash Date 02/05/2017This report does not include any CJIS data.
7of7
Wisconsin Motor Vehicle Crash
Form DT4000