20170804 Burmeister Bishop17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM 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
03
Total Units
02
Time Notified
04:14 PM
Date Notified
08/04/2017
Time Arrived
04:29 PM
Date Arrived
08/04/2017
Crash Time
04:13 PM
Crash Date
08/04/2017
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
3
Z
Q
K
R
M
Additional InformationPhotos, Reconstruction
Photos ByFREY397
Reconstruction ByWISCONSIN STATE PATROL
NWR/SPO
Diagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1, A PASSENGER CAR, WAS IN TRANSIT, TRAVELING WEST ON COUNTY ROAD W NEAR FIRE NUMBER 4553. UNIT 2, A FARM TRACTOR, WAS ALSO TRAVELING WEST. UNIT 2 BEGAN A TURN INTO 4553W COUNTY HIGHWAY W. THE PASSENGER CAR STRUCK THE REAR DRIVERS SIDE TIRE
OF THE TRACTOR, SPINNING THE TRACTOR AROUND, AND ROLLING THE TRACTOR OVER. THE OPERATOR OF UNIT 2, THE TRACTOR, WAS
EJECTED 30' WEST OF THE FINAL RESTING PLACE OF THE TRACTOR. THE DRIVER AND PASSENGER OF THE PASSENGER CAR WERE UNABLE TO
EXIT THE VEHICLE WITHOUT EXTRICATION. THE DRIVER AND PASSENGER OF UNIT 1 WERE TAKEN BY AMBULANCE TO RUSK COUNTY HOSPITAL,
AND THE OPERATOR OF UNIT 2 WAS AIRLIFTED TO ST MARY'S IN DULUTH BY NORTH MEMORIAL.
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5077449
X Coordinate
196312.453125
Longitude
-90.90686378
Latitude
45.783762574
ON CTHW
0.87 MI E
OF TOWER RD
IN THE TOWN OF WINTER
IN SAWYER COUNTY
Location
Special StudyAccess Control
Full Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - On Road
Animal Type
Weather Condition(s)
Cloudy
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
02--Front To Rear
First Harmful Event Location
On Roadway
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Time Roadway RepairedDate Roadway RepairedTime All Lanes Open
07:48 PM
Date All Lanes Open
08/04/2017
Time Initial Lane/Road Closed
04:29 PM
Date Initial Lane/Road Closed
08/04/2017
Reasons for Closure
Law Enforcement, Tow truck, Fire/EMS, Med Flight
Closure Type
Full closure
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
Unknown
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
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
Model
RIVIERA
Year
1995
Make
BUICK
Vehicle Identification Number
1G4GD2214S4707601
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
917UYZ01
Vehicle
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver ActionsOther Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Overtake Left
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 11--Left Front Corner, 12--Front
Initial Contact Point
11--Left Front Corner
Bus UseNot A BusBody Style
CP - COUPE
Color
BLK - Black
VE
H
I
C
L
E
UN
I
T
Address
WAUTOMA, WI 54982 , US
IndividualGARY LEE BURMEISTER01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventUnknown02
EventUnknown03
EventUnknown04
Individual
GARY BURMEISTER
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
Individual Condition
Not Observed
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
RUSK COUNTY MEMORIAL HOSPITAL AND NU
EMS Run #
10582
EMS Agency Identifier
12345
Medical Transport
EMS Ground
Trapped/Extricated
Trapped/Extricated
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Deployed-Front
Injury Severity
Suspected Serious 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
WAUTOMA, WI 54982 , US
RaceWHITEDate of Birth
03/13/1
Sex
Male
Citations Issued
0
DriverGARY LEE BURMEISTER
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
Individual Condition
Not Observed
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
RUSK COUNTY MEMORIAL HOSPITAL AND NU
EMS Run #
10582
EMS Agency Identifier
12345
Medical Transport
EMS Ground
Trapped/Extricated
Trapped/Extricated
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Deployed-Front
Injury Severity
Suspected Serious 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
WAUTOMA, WI 54982 , US
RaceWHITEDate of Birth
11/26/1
Sex
Female
Citations Issued
0
PassengerHEATHER JEAN JANZEN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM 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
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Farm Tractor/Self Propelled
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsUnknown If Distracted
Driver ActionsUnknown
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Left Turn
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Disabling Damage
Vehicle Damage
5--Right Rear Corner, 6--Rear, 7--Left Rear Corner
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
TC - TRACTOR
Color
RED - Red
Model
FARMALL
Year
1972
Make
INTERNATIONAL
Vehicle Identification Number
15
Country of IssuanceStPlate TypeLicense Plate Number
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
WINTER, WI 54896 , US
IndividualCLINTON N BISHOP02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport05
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
EventLeft Turn06
EventUnknown07
EventUnknown08
Individual
CLINTON BISHOP
Insurance Company
KAREN EHN WINTER INS
Policy Holder
UN
I
T
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 8
This report does not include any CJIS data.
17080407
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRM Wisconsin Motor Vehicle
Crash Report
Individual Condition
Not Observed
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
02
Time of DeathDate of DeathHospital
ST MARYS MEDICAL CENTER
EMS Run #EMS Agency Identifier
12345
Medical Transport
EMS Air
Trapped/Extricated
Not Applicable
Ejection Path
Other Path (E.G., Back Of Pickup
Ejected
Totally Ejected
Airbag
Not Applicable
Injury Severity
Suspected Serious 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
3
Safety Equipment
None Used - Vehicle Occupant
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
WINTER, WI 54896 , US
RaceWHITEDate of Birth
03/02
Sex
Male
Citations Issued
0
DriverCLINTON N BISHOP
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 04:13 PM
Crash Date 08/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 8
This report does not include any CJIS data.