20170811 Schuck17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 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
02:20 PM
Date Notified
08/11/2017
Time Arrived
02:29 PM
Date Arrived
08/11/2017
Crash Time
12:00 PM
Crash Date
08/11/2017
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash Number
17081103
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
K
5
Additional InformationPhotos
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON AUGUST 11, 2017, I DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPT. AT APPROXIMATELY 14:20 I WAS DISPATCHED TO WILDERNESS WALK ON STATE HWY 27 FOR A HIT AND RUN ACCIDENT. UPON ARRIVAL I MET WITH JORDAN SCHUCH
WHO WAS WORKING THERE. SHE STATED AT APPROXIMATELY 13:30 SHE CAME OUTSIDE TO GET SOMETHING OUT OF HER VEHICLE AND NOTICED
A DENT ON THE PASSENGER FRONT SIDE. SHE SAID SHE ATTEMPTED TO OPEN THE DOOR AND IT WAS HARD TO OPEN AND WOULD NOT FULLY
SHUT RIGHT AFTER THAT. SHE STATED NO ONE HAD SEEN WHAT HAD HAPPENED AND THE DENT WAS NOT THERE BEFORE SHE CAME TO WORK.
JORDAN STATED SHE IS UNSURE WHAT TIME IS HAPPENED IT, BUT SHE NOTICED IT AT 13:30 AND CALLED HER MOM RIGHT AWAY. I INFORMED
HER SHE WILL NEED TO CONTACT HER INSURANCE COMPANY AND LET THEM KNOW AND THEY WILL TELL HER WHAT TO DO FROM THERE. I TOOK PICTURES OF THE DAMAGE TO THE VEHICLE WHICH APPEARED TO BE MINOR. I INFORMED JORDAN THAT SHE WILL NEED TO GET AN ESTIMATE
ON HER VEHICLE DAMAGE AND ASKED THAT SHE CALLED ME TO LET ME KNOW WHAT IT WAS WHEN SHE GOT IT. JORDAN ALSO INFORMED ME
THAT SHE HAD SECURA INSURANCE THAT HER PARENTS WERE THE POLICY HOLDERS OF. I CLEARED THE CALL AT 14:59. I ENTERED THE
PHOTOGRAPHS INTO EVIDENCE AS ITEM NUMBER 1700543-0001. THIS IS ALL THE INFORMATION I HAVE AT THIS TIME.
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 Wisconsin Motor Vehicle
Crash Report
Structure Type
House/Building
Y Coordinate
5101503.5
X Coordinate
151562.765625
Longitude
-91.498306954
Latitude
45.978493488
ON 9503 STH27 NB
67 FT N
OF FUN VALLEY RD
(HOUSE/BUILDING 9503)
IN THE TOWN OF BASS 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
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
08--Front To Side
First Harmful Event Location
Off Roadway, Location Unknown
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
Unknown
Road Curvature
Unknown
Surface Type
Unknown
Traffic Control Inoperative/Missing
UNKNOWN
Traffic Control
Unknown
Traffic Way
Unknown
Emergency Motor Vehicle UseUnknownSpecial FunctionUnknownMost Harmful Event: Collision With
Parked Motor Vehicle
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
Unknown
Insurance?
UNKNOWN
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
Hit and Run
UN
I
T
01
Unit Summary
Extent Of Damage
Unknown
Vehicle Damage
Unknown
Initial Contact Point
Unknown
Bus UseNot A BusBody StyleColor
ModelYearMakeVehicle Identification Number
Country of IssuanceStPlate TypeLicense Plate Number
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
Unknown
Driver Prior Action Other
Vehicle Factors
Unknown
What Driver Was Doing
Unknown
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
, ,
Unknown
01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Event
02
Event
03
Event
04
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 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 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
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 Wisconsin Motor Vehicle
Crash Report
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Straight
Surface Type
Slag, Gravel, or Stone
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
10Pre 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
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
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Functional Damage
Vehicle Damage
1--Right Front Corner, 2--Right Side Front
Initial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
4D - 4DR
Color
RED - Red
Model
IMPALA
Year
2009
Make
CHEVROLET
Vehicle Identification Number
670
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
682XCA
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
IndividualALLAN M SCHUCK02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
17081110930
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HK5 Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
ALLAN SCHUCK
Insurance Company
SECURA-INS-A-MUTUAL-CO
Policy Holder
UN
I
T
Crash Time 12:00 PM
Crash Date 08/11/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.