HomeMy WebLinkAbout23-1789 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-1789 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 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 02 - 1-- 2023 0639 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
ABERDEEN AVE NE BLOCK NO. e✓ 2000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e NE 20TH ST
0 1 29
MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 6 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY 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 9� P1 ATE 14 UNKNOWN STATE WA VIN#' UNK
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 5 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 4 JEEP WRANG UT DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14[WI LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VE'CLE CHARGE 1 5 36
LEGALLv 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:2063728703
16 a
LAST NAME TSIBELENKO FIRST NAME OKSANA MIDDLE g
INITIAL
17 STREET❑ NEW ADDRESS❑' 12943 SE 288TH PL CITY AUBURN ST WA ZIP 980922175 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVEW # STATE WA ]SEX IF M .C.B. 02 _ 24 1981 0 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 'NE 1 NATURE OF INJURIES 40
❑21❑ PLATE# BKJ3405 TATE 41
WA VIN# 3N1CN7APXHK456453 4
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE NISS MODEL VERSA STYLE 4D VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO OKSANA TSIBELENKO 12943 SE 288TH PL AUBURN WA 98092 D:2063728703 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO SAFECOX6354416IN 1 9TOP
vETILe ES❑ N J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY Y
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.JAC08S 1953 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38546
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1789
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'
On 2-13-23 at about 0648 1 arrived in the 1600 block of Aberdeen Ave NE for a hit and run collision. I
contacted driver 2, Oksana TSIBELENKO sitting in her vehicle, WA plate BKJ3405. There was heavy
damage to the rear of unit 2. TSIBELENKO told me;
She delivers papers early in the morning.
This morning the driver of unit 1 became upset with her, but she does not know why. Driver 2
rammed her vehicle from the rear while she was driving slowly in the 2000 block of Aberdeen Ave
NE..
She described unit 1 as a newer white Jeep with a brush guard on the front.
Driver 1 yelled something at her before driving off.
She was too shook up to describe the driver of unit 1.
She did not get a license plate of unit 1.
She is not familiar with unit 1.
She has been doing her current route for years and has never had a problem before today.
She requested a tow truck.
There is no other suspect information.
This incident occurred in the city of Renton, County of King.
I declare under the penalty of perjury under the laws of Washington state that the foregoing is true
and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 02-13-23 07:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 31112023 11:39:20 AM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 6:43 AM TIME POLICE ARRIVED 6:48 AM
PART I PAGE IT]OF
REPORT NO. ED38546 CASE# 23-1789 DATE AND TIME 02/13/23 06:39
OF COLLISION
.199m,411111m..
� qw
z
2000 Block of Aberdeen Ave NE
PAGE 3 OF 3