20170422 Schultz17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
Private Property/Parking LotReportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
02
Time Notified
09:07 AM
Date Notified
04/22/2017
Time Arrived
09:17 AM
Date Arrived
04/22/2017
Crash Time
09:07 AM
Crash Date
04/22/2017
Investigating Officer/Deputy
DEPUTY JAY POPLIN
Agency Crash Number
17042204965
Primary Crash Document #Document Number Override
6V
L
1
3
J
5
5
J
R
Additional InformationPhotos
Photos ByPOPLIN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS BACKING OUT OF THEIR PARKING SPOT AT THE LCO CASINO PARKING LOT. UNIT 1 BACKED INTO UNIT 2 WHICH WAS UNOCCUPIED AT THE TIME. BOTH VEHICLES SUSTAINED MINOR DAMAGE AND NO ONE WAS HURT IN THE INCIDENT.
Structure Type
House/Building
Y Coordinate
5102897
X Coordinate
160597.078125
Longitude
-91.383013138
Latitude
45.995525583
PARKING LOT
CTHK LOT 13767W
(HOUSE/BUILDING 13767W)
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of1
Wisconsin Motor Vehicle Crash
Form DT4000
17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Non Trafficway - Parking Lot
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
04--Rear To Rear
First Harmful Event Location
In Parking Lane or Zone
First Harmful Event
Parked Motor Vehicle
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
Level
Road Curvature
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Parked Motor Vehicle
Total Lanes
0
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
Train/Bus # InjuredTotal Occs
1
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
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
Minor Damage
Vehicle Damage
6--Rear
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
TK - TRUCK
Color
RED - Red
Model
F250
Year
1990
Make
FORD
Vehicle Identification Number
1FTEF14Y8LLA20090
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
222293F
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of2
Wisconsin Motor Vehicle Crash
Form DT4000
17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Unsafe Backing
VE
H
I
C
L
E
UN
I
T
Address2657 5 1/2 AVE
NEW AUBURN, WI 54757 , US
IndividualJOHN C SCHULTZ01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Event
02
Event
03
Event
04
Individual
JOHN SCHULTZ
Insurance Company
ALL-AMERICA-INS-CO
Policy Holder
UN
I
T
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of3
Wisconsin Motor Vehicle Crash
Form DT4000
17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR 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
Restraint Use Unknown
On Duty Crash
01
Driver License NumberS4327396304106
State: Wisconsin Country: UNITED STATES
Address2657 5 1/2 AVE
NEW AUBURN, WI 54757 , US
RaceWHITEDate of Birth
02/01/1963
Sex
Male
Citations Issued
1
DriverRALPH WILLIAM SCHULTZ
(715) 441-7868
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Violations
DescriptionUNSAFE BACKING OF VEHICLESeq Num001Statute Number346.87Issue To?
001
UTC Number
E01494701
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of4
Wisconsin Motor Vehicle Crash
Form DT4000
17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR Wisconsin Motor Vehicle
Crash Report
Reporting Threshold
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
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
0
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
NOT APPLICABLE
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
0
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
Legally Parked
UN
I
T
02
Unit Summary
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Legally Parked
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Minor Damage
Vehicle Damage
6--Rear
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
4D - 4DR
Color
BGE - Beige
Model
MALIBU
Year
2012
Make
CHEVROLET
Vehicle Identification Number
1G1ZC5EU8CF339512
Country of Issuance
UNITED STATES
St
MI
Plate Type
AUT - Automobile
License Plate Number
BEQ072
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address206 S HEMLOCK ST
PO BOX 186
IRONWOOD, MI 49938 , US
IndividualJAMES E BAROSS
(906) 932-806602
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of5
Wisconsin Motor Vehicle Crash
Form DT4000
17042202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55JR Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Crash Time 09:07 AM
Crash Date 04/22/2017This report does not include any CJIS data.
6of6
Wisconsin Motor Vehicle Crash
Form DT4000