HomeMy WebLinkAbout25-80519 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-80519 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AGENCI 4Y50 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION.. 12 - 08 - 2025 1919 17 . N E IN� S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAIN AVE S BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 4TH ST
0 1 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE O 3 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY LAKE STEVENS ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10[1PI ATE 14 BCZ7997 sTAT WAu N# 1 FAHP34372W139925
0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. RLR 1 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 7 34
13 4 2002 FORD FOCUS SD DAMAGE YES NO YES
❑ NO✓
REGISTERED OWNER INFO ,JAN PETERSON III AVE SE LAKE STEVENS WA 98258 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEIF" CHARGE 1 5 36
LEGALLv YEs❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ PRO PE ❑ YES 1/ No D:8083211973
16 a
LAST NAME TAPAWAN FIRST NAME MIANNA MIDDLE G
INITIAL
17 STREET 1 NEW ADDRESS❑' 9624 FRONTIER AVS SE UNITH408 CITY' SNOQUALMIE ST' WA ZIP 98065 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 DRIVER'S STATE WA ]SEX IF I D.C.B. 07 O6 _ 1989 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# AYT9041 TATE WA VIN 1 41
JTEBUSJRXG5303500 `1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR 2016 MAKE TOYT MODEL 4RUNNER STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MIANNA TAPAWAN 9624 FRONTIER AVS SE UNITH408 SNOQUALMIE WA 98065 D:8083211973 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO PROGRESSIVE 963815781IN 1 9TOP
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLYN
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG58495
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80519
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
PM 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.
KEITH PETTY 12-08-25 09:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THiELMAN 11462 1 1211312025 10:37:35 PM
BADGE OR ID# ( 12809 ORI# WA0171300 TIME POLICE DISPATCHED; 7:20 Pry] TIME POLICE ARRIVED 7:30 PM
PART I PAGE IT]OF
REPORT NO. EG58495 CASE# 25-80519 OF COLLISION
12/08/25 19:19
OF CbLLI510N
NARRATIVE
25-80519
On 11/01/2025 at approximately 1904 hours, I was dispatched to the intersection of S Grady Way and
Rainier Ave S in the City of Renton, County of King, State of Washington for a recent hit and run with
no injuries.
I contacted unit 2 driver, Mianna Grace G Tapawan (DOB 07/06/1989) driving her red 2016 Toyota 4-
Runner (AYT9041/WA) VIN/JTEBU5JRXG5303500.
Unit 1 was a red 2002 Ford Focus (BCZ7997/WA) VIN/1 FAHP34372W139925, registered to a Jan
Marie Peterson (DOB 10/13/1960) and a Jerrilyn Run Qing Peterson (DOB 01/03/1999)
Unit 2 stated she had been heading south on main Ave S and was turning right onto S 4th St. Unit 1
had been behind her and collided into the driver side rear bumper causing approximately $1000 in
damage.
Unit 1 did not stop and unit 2 was not able to see the driver.
I provided the case number to Mianna.
Unit#1 (SUSPECT) committed one (1) count of Hit-and-Run -Attended by being involved in an
accident with another vehicle, which is attended, and failing to stop and remain at the scene until
fulfilling all statutory duties (provide name, address, insurance company, policy, vehicle license,
exhibit driver's license and render reasonable assistance to any person injured).
This incident was captured on my body-worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 12/08/25at 2004 hours, Place: Renton, King County, WA
PAGE 3 OF 5
REPORT NO. EG58495 CASE# 25-80519 OF COLLISION
12/08/25 19:19
OF CbLLI510N
NARRATIVE
PAGE 4 OF 5
REPORT NO. EG58495 CASE# ' 25-80519 DATE AND TIME 12/08/25 19:19
OF COLLISION
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PAGE 5 OF 5