HomeMy WebLinkAbout25-9550 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# zs-ssso 2 676
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 11 - 1-- 2025 1715 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
NE SUNSET BLVD e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e ABERDEEN AVE NE
0 1 29
MOTUNIT O1 VEHICR Z PEDAL-CLE CYCLE ElYYESA�NO THRESHOLD MET PHONE 0 11
30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY KENT
NEW ADDRESS ST ZIP'. 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICIENSE#
STATE I
SEX'M MMDDYY _ — 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 6 RESTR 4 EJECT 1 H USEET 9 CLAY 0 NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 CPY6425 STATE WA VIN# 5N1AN08W65C648099
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE IMODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 7 34
13 2005 NISS XTERRA UT DAMAGE vEs 0NO �LII� RS TOWING ves❑ No
REGISTERED OWNER INFO SILVIA LEPE GARCIA 23501112THAVE SE APT F104 KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE❑ INSURANCE CO
IN EFFECT &POLICV# �1'OP
vE EFFECT
CHARGE ❑ 36
LEGALLY YES❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:9039413548
16 2
LAST NAME PICHETTE FIRST NAME CIARA MIDDLE N
INITIAL
17 STREET NEW ADOREs�' 2955 NE 11 TH ST UNIT A 616 CITY RENTON ST WA ZIP 98058 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO INTERLOCK YEs❑NOF YES
❑NOF,/
19 DIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLATE# WHT0991 TATE 41
TX vIN1 1FMJK1HS6CEF15429 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE FORD MODEL EXPEDITI STYLE (I7' VEHICLE TOWED TO BLIN
TOWED By Gov HI 44
24 DAMAGE YES NO BANKERS TOWING YES NO
REGISTERED OWNER INFO [NEWJ VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.EDMUNDS 12576 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG45059
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9550
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PICHETTE BLARE
(LAST FIRST,
ADDRESS&PHONE# D O.B.
RENTON SEX U MMDDYYYY 01 - 04 - 2021
PASSENGER Z WITNESS 'UNIT# j 2 POS 7 AIRBAG 2 RESTR. 4 EJECT ? 1 H USE
ET 2 CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) PICHETTE BENTLEY
ADDRESS&PHONE# D O B
RENTON SEX: U MM 0-:vB v 09 _ 16 _ 2015
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS UNIT# 2 PCS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see attached police report#25-9550 , which is hereby incorporated by reference as if fully set
forth herein.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.EDMUNDS 11-03-25 07:28 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 111412025 10:57:59 PM
BADGE OR ID# ` 12576 ORI#' WA0171300 TIME POLICE DISPATCHED! 5:15 PM TIME POLICE ARRIVED',5:15 PM
PART I PAGE IT]OF 3�
REPORT NO. EG45059 CASE# 25-9550 DATE AND TIME 11/03/25 17:15
OF COLLISION
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PAGE 3 OF 3