20170524 Flint DefoeSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS 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
11:30 AM
Date Notified
05/24/2017
Time Arrived
11:54 AM
Date Arrived
05/24/2017
Crash Time
11:28 AM
Crash Date
05/24/2017
Investigating Officer/Deputy
DEPUTY JEFF CAIN
Agency Crash Number
17052402
Primary Crash Document #Document Number Override
6V
L
1
3
M
V
8
V
S
Additional InformationPhotos, Other Documents
Photos ByDEPUTY JEFF CAIN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
OPERATOR OF UNIT 1 HAD JUST BACKED FROM A PARKING SPACE AND BEGAN TO PROCEED FORWARD WHEN THE DRIVER OF UNIT 2 BEGAN BACKING FROM A PARKING SPACE AND BACKED INTO THE SIDE OF UNIT 1
Structure Type
House/Building
Y Coordinate
5105156
X Coordinate
152975.96875
Longitude
-91.482770127
Latitude
46.011983954
PARKING LOT
MINNESOTA AVE LOT 10514 MAIN
(HOUSE/BUILDING 10514 MAIN)
IN THE CITY OF HAYWARD
IN SAWYER COUNTY
Location
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of1
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
Private Property
Crash Classification - Location
Private 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
07--Rear To Side
First Harmful Event Location
In Parking Lane or Zone
First Harmful Event
Motor Veh In Transport
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
Motor Veh In Transport
Total LanesSpeed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
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
Going Straight
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
Minor Damage
Vehicle Damage
3--Right Side Middle
Initial Contact Point
3--Right Side Middle
Bus UseNot A BusBody Style
4D - 4DR
Color
SIL - Silver (Aluminum)
Model
FUSION
Year
2014
Make
FORD
Vehicle Identification Number
320225
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
983ZKJ
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of2
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
No Contributing Action
VE
H
I
C
L
E
UN
I
T
Address
HAYWARD, WI 54843 , US
IndividualCOLEEN M FLINT01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Event
02
Event
03
Event
04
Individual
COLEEN FLINT
Insurance Company
ERIE-INS-CO
Policy Holder
UN
I
T
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of3
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS 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
Driver License NumberF4531134950705
State: Wisconsin Country: UNITED STATES
Address1
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
01/07/
Sex
Female
Citations Issued
0
DriverCOLEEN M FLINT
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of4
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS 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 LanesSpeed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
NO
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
(Sport) Utility Vehicle
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsUnknown If Distracted
Driver ActionsUnsafe Backing
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
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
UT - SPORT UTILITY VEHICLE
Color
SIL - Silver (Aluminum)
Model
PACIFICA
Year
2004
Make
CHRYSLER
Vehicle Identification Number
80812
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
NC9446
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address N
HAYWARD, WI 54843 , US
IndividualREGINALD L MASEY02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of5
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VS Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
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
02
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
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
mber
State: Wiscon in Country: UNITED STATES
Address
BAYFIELD, WI 54814 , US
RaceINDIANDate of Birth
11/24/
Sex
Female
Citations Issued
0
DriverAMANDA J DEFOE
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 11:28 AM
Crash Date 05/24/2017This report does not include any CJIS data.
6of6
Wisconsin Motor Vehicle Crash
Form DT4000