HomeMy WebLinkAbout23-4220 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-4220 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4250 3
HIT&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# ❑
cowsloN 04 - 1-- 2023 2028 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 307
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ J.❑ FEET MILES e S B W e SW SUNSET BLVD
0 1 29
UNIT MOTOOR � CYCLE ❑ DYESA✓NOESHOLDMET PHONE O 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 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❑ LICIENSE#
STA fE I
SEX u MMDOBYY - 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❑ P1ATE14 C12390M STATE WA VIN# 1FTRX18L1XKC01962
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. A'RLA2 1 5 33
12 0 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 3 1999 FORD F150 TR DAMAGE vEs 0NO f �LII� RS vEs❑ No
REGISTERED OWNER INFO LORENZO SANCHEZ 37326 AUBURN ENUMCLAWRD SE AUBURN WA 98092 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NIA 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs No 1/ D:2533240345
16 a
LAST NAME TIETJEN FIRST NAME MIKAYLA MIDDLE IL
INITIAL
17❑ NEW STREETREs7 24602 SE SUMMIT LANDSBURG RD CITY RAVENSDALE ST WA ZIP 98051 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYEB❑No� INTERLOCK ves No� YES
NOFI
19[-] DRIVER'S STATE WA SEX F D.C.B. 05 _ 05 _ 2000 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CFD0805 TATE 41
WA VIN# 1FMDESDH9NLB60315 4
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2022 MAKE FORD MODEL BRONCO STYLE 4D DAMAGE TOWED NOO✓ BLIN TOWED By ov HYES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO USAA 0408652707101IN I 9TOP
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J RAYGOZA 12503 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52142
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4220
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 FIRST 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'
RPD CASE#: 23-4220
On 04/14/2023 at approximately 2033 hours, I responded to 307 Rainier Ave S, in the City of Renton,
King County, Washington, for a report of a non-injury motor vehicle accident.
Upon arrival I saw unite 1 later identified as a 1999 green Ford F150 WA/LICC12390M
VIN#1 FTRX18L1 XKC01962 parked on the street facing south on Rainier Ave S with heavy damage
to the front of the vehicle. Unit 1 was unoccupied, and the driver of the vehicle was nowhere to be
found.
I identified unit 2 as a green 2022 Ford Bronco WA/LICCFD0805 VIN#1 FMDE5DH9NLB60315 that
was parked in the O'Reilly's parking lot on Rainier Ave S just west of where the collision occurred.
The driver of the vehicle later identified by her WADOL as Tietjen, Mikayla Lynn DOB (05/05/2000)
was next to her vehicle crying and on the phone. I spoke to Tietjen, and she said she was driving
southbound on Rainier Ave S when she was rear ended by unit 2 who was driving behind her. Tietjen
was too scared and shocked that she was involved in a collision and didn't see the driver of unit 1
when they ran away. Tietjen had no visible injuries and unit 2 sustained minor damage to the rear end
of the vehicle.
Unit 1 was towed from the scene by Bankers and Tietjen received my business card with the case
number. Due to the driver of unit 1 not being at the location I was unable to cite the driver with a
citation.
Once both vehicles were out of the area, I cleared the scene.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Raygoza on 04/15/2023 at 0430 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J RAYGOZA 04-15-23 04:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 411712023 5:43:31 PM
BADGE OR ID# 12503 OR]# WA0171300 TIME POLICE DISPATCHED 8:33 PM TIME POLICE ARRIVED';8:42 PM
PART I PAGE IT]OF
REPORT NO. ED52142 CASE# 23-4220 DATE AND TIME 04/14/23 20:28
OF COLLISION
Unit 1 N
0
J!
Unit 2:
V9
0
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