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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.