20170809 MertensSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V 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
10:49 PM
Date Notified
08/09/2017
Time Arrived
11:23 PM
Date Arrived
08/09/2017
Crash Time
10:49 PM
Crash Date
08/09/2017
Investigating Officer/Deputy
DEPUTY NICOLE RIPCZINSKI
Agency Crash Number
17080606
Primary Crash Document #Document Number Override
6V
L
1
3
1
B
Q
6
V
Additional InformationPhotos
Photos ByN. RIPCZINSKI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON AUGUST 6, 2017 I, DEPUTY RIPCZINSKI WAS DISPATCHED TO THE AREA OF 10749N TIGER CAT RD FOR A REPORT A VEHICLE ROLL-OVER NEAR THAT ADDRESS. I ARRIVED ON-SCENE AND OBSERVED A SILVER FOUR-DOOR VEHICLE ROLLEDOVER ON THE EAST SHOULDER OF TIGER CAT RD
ON ITS HOOD. THE VEHICLE APPEARED TO HAVE BEEN TRAVELING NORTHBOUND ON TIGER CAT RD. I LOOKED UNDER THE VEHICLE AND DID NOT
OBSERVE ANYONE IN, NEAR, OR AROUND THE VEHICLE. DEPUTY NELSON ALSO ARRIVED ON-SCENE AND OBSERVED SAME. THERE WAS A SMALL
ODOR OF INTOXICANTS FROM THE VEHICLE. ROADRUNNER HAD BEEN NOTIFIED BY THE REGISTERED OWNER OF THE VEHICLE AND ROADRUNNER
TOWING CALLED IN THE ACCIDENT. NO ONE INVOLVED IN THE CRASH CALLED THE SHERIFF'S DEPARTMENT. AFTER THE VEHICLE WAS UPRIGHT,
THERE WAS ONE OPEN CAN OF COORS LIGHT IN THE VEHICLE AND AN UNOPEN CAN OF COORS LIGHT. THERE WAS NO OTHER ALCOHOL OR DRUGS LOCATED IN THE VEHICLE. THE REGISTERED OWNER WAS CONTACTED. THE REGISTERED OWNER ADVISED THAT THE REGISTERED
OWNER WAS NOT THE OPERATOR OF THE VEHICLE AND THAT THE OPERATOR OF THE VEHICLE HAD TAKEN OFF ON FOOT IMMEDIATELY
FOLLOWING THE ACCIDENT. THE REGISTERED OWNER OF THE VEHICLE ADVISED THAT THERE WERE 4 OCCUPANTS ALL TOGETHER 2 OF WHICH
WERE KNOWN, THE OPERATOR WHICH WAS NOT. THE VEHICLE WAS REMOVED BY ROADRUNNER TOWING AND CITATIONS WERE MAILED TO THE
REGISTERED OWNER. SEE FULL REPORT. END OF NARRATIVE.
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5105430
X Coordinate
170302.375
Longitude
-91.259783799
Latitude
46.022993442
ON TIGER CAT RD
0.38 MI S
OF TIGER CAT DAM RD
IN THE TOWN OF ROUND 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 - On Road
Animal Type
Weather Condition(s)
Clear
Environment Factor(s)
None
Roadway Factor(s)
Not Applicable
Road Surface Condition(s)
Dry
Light Condition
Dark/Unlit
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Left
First Harmful Event
Ditch
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
Curve Left
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
Overturn/Rollover
Total Lanes
2
Speed Limit
45Pre CrashTire
Mark
Direction Of Travel
Southbound
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
Train/Bus # InjuredTotal Occs
4
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
Hit and Run
UN
I
T
01
Unit Summary
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 2--Right Side Front, 3--Right Side Middle, 8--Left Side
Rear, 9--Left Side Middle, 10--Left Side Front, 11--Left Front Corner
Initial Contact Point
Undercarriage
Bus UseNot A BusBody Style
SD - SEDAN
Color
SIL - Silver (Aluminum)
Model
TAURUS
Year
2007
Make
FORD
Vehicle Identification Number
758
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
583ZYL
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
Failure To Control, Failed To Keep In Designated Lane, Operated Motor Vehicle In Inattentive, Careless or Erratic Manner
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Negotiating Curve
Vehicle Removed By
OPERATOR
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualJORDAN C MERTENS01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventDitch01
EventTree02
EventOverturn/Rollover03
Event
04
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V 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
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
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
None Used - Vehicle Occupant
On Duty Crash
01
Driver License NumberM6354239830109
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
08/21
Sex
Male
Citations Issued
1
PassengerJORDAN C MERTENS
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V 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
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
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
None Used - Vehicle Occupant
On Duty Crash
01
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
08/29
Sex
Male
Citations Issued
0
PassengerLOGAN A THAYER
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V 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
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
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
3
Safety Equipment
None Used - Vehicle Occupant
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
05/27/
Sex
Male
Citations Issued
0
PassengerSTEVEN P SMITH
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V 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
4
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
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
4
Safety Equipment
None Used - Vehicle Occupant
On Duty Crash
01
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Driver
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Violations
DescriptionFAILURE OF OCCUPANT TO NOTIFY POLICE OF ACCIDENTSeq Num004Statute Number346.70(1)Issue To?
001
UTC Number
AE01412601
AddressUnknown01
Property Owner
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 8
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6V Wisconsin Motor Vehicle
Crash Report
, ,
PR
O
P
OW
N
E
R
Fixed Objects Struck
Damage Tag NumberStruck Object
Ditch
Striking Unit
0101
Damage Tag NumberStruck Object
Tree
Striking Unit
0102
Crash Time 10:49 PM
Crash Date 08/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 8
This report does not include any CJIS data.