HomeMy WebLinkAbout20181221 STONER.pdf18122105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
NON-DOMESTICATED ANIMAL W/ NO INJURYReportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
04:58 PM
Date Notified
12/21/2018
Time ArrivedDate ArrivedCrash Time
04:57 PM
Crash Date
12/21/2018
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
3
J
5
5
K
X
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
NO STRUCTURE
Y Coordinate
5111651
X Coordinate
189986.9375
Longitude
-91.010151509
Latitude
46.088037101
ON STH77 EB
104 FT N
OF MEADOW LAKE RD
IN THE TOWN OF SPIDER LAKE
IN SAWYER COUNTY
Location
Special StudyAccess ControlTribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
DEER
Weather Condition(s)
Environment Factor(s)
Roadway Factor(s)Road Surface Condition(s)
Light ConditionManner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Road GradeRoad CurvatureSurface Type
Traffic Control Inoperative/MissingTraffic ControlTraffic Way
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
PASSENGER VAN01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Crash Time 04:57 PM
Crash Date 12/21/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
18122105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Truck Bus or HazMat
NO
Owner AddressOwner Name
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle FactorsWhat Driver Was Doing
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
11--LEFT FRONT CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
4D - 4DR
Color
RED - RED
Model
CARAVAN
Year
2017
Make
DODGE
Vehicle Identification Number
52800101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
UN
I
T
VE
H
I
C
L
E
IndividualInsurance Company
WILSON-MUTUAL-INS-CO
Policy Holder
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
SIREN, WI 54872 , US
Race
WHITEDate of Birth
07/16/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 04:57 PM
Crash Date 12/21/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
18122105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13J55KX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/ExtricatedEjection PathEjected
AirbagInjury Severity
NO APPARENT INJURY00
1
01
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 04:57 PM
Crash Date 12/21/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.