HomeMy WebLinkAbout23-05503 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-05503 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 5 1 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 05 - 1-- 2023 2159 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FEET e MILES S ❑ W e QUEEN AVE NE
0 1 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE# STATE SEX u MMDORYY - 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI vrN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 4 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12❑ vIN# UIN#
FROM TO
❑ VEH.YEAR MAKE KIA MODEL UNKOW STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTEREDOWNERINFO UKNOWNUNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ ABILI INSURANCE❑ IN CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252677012
16❑
LAST NAME SKINNER FIRST NAME TALIA SHALECE MIDDLE IV
INITIAL
17❑ STREET ADOREss❑' 4600 DAVIS AVE S,APT N202 CITY RENTON ST WA ZIP 98055 37
❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES It I NOF YES l NO❑
19 DRIVE # STATE ]SEX IF MMDDYY 11 29 _ 1998 39
ON DUTY STATUS 0 AIRBAG RESTR EJECT HELMET INJURY 6 NATURE of INJURIEs 40
USE CLASS MINOR
❑21❑ LICENSE TATE 'l 41
`1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 ] DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HUBERMANN ALCEAN 12681 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED61926
COLLISION REPORT III III III III III 111
1591972 CASE# 23-05503
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HUBERMANN ALCEAN 05-16-23 04:49 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 512012023 11:32:12 AM
BADGE OR ID# 12681 ORI#' WA0171300 TIME POLICE DISPATCHED 10:00 PM TIME POLICE ARRIVED',10:01 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED61926 CASE# 23-05503 OF COLLISION
05/15/23 21:59
OF CbLLI510N
NARRATIVE
Assignment:
On 05/15/23 at approximately 2200 hours, I was dispatched to 3709 ne 4TH St to a report of a vehicle
vs pedestrian collision. This address is in the City of Renton, County of King, State of Washington.
Upon arrival, I observed a female subject sitting down in the turning lane crying. Other officers at the
scene were helping her. I also observed she had injury to her right knee. Renton Fire Department
shortly arrived on scene and took care of her injury. She declined to go to the hospital.
She was later identified as Talia Shalece. V Skinner (DOB 12/29/1998).
When I asked Skinner what happened, and she said the following.
She said she lives at the Cedar Park Apartment located on NE 4th ST and Monroe and was going
home when the collision happened. She was on her scooter in the turning lane going westbound on
NE 4th when she was hit from the back by a grey Kia. She felt on to the ground. She said the driver of
the grey Kia then turned around and fled the scene heading eastbound on NE 4th St.
When asked she was not able to provide a detailed description or the driver.
I provided Skinner with a case # 23-5503.
Other Officers at the scene took photographs of Skinner's knee injury and her scooter for evidence.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
This report was electronically signed by Officer H. Alcean #12681, May 16, 2023, at 0322, Renton,
WA
PAGE 3 OF 4
REPORT NO. ED61926 CASE# 23-05503 DATE AND TIME 05/15/23 21:59
OF COLLISION
LU millill
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Uj
EAST
LU
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WEST
NE 4th St
PAGE 4 OF 4