2834-24 Mitchell-Valley-All-Way-Stop-Report.pdf

121b HENOK -- MENGSTAB M WELLINGTON O CUMMINGS M 01 -- 103 27. Number & Street 57. Number & Street 01 7725 BRISTOL SQUARE CT 261 CAMDEN STREET 104 122 2 28. City State Zip 58 City State Zip 03 SPRINGFIELD VA 22153 NEWARK NJ 07103-2472 123 30. Eyes DL Class Restrictions Endorsements 31. State 60. Eyes DL Class

DL Class Restrictions Endorsements 31. State 60. Eyes DL Class Restrictions Endorsements 61. State 01 02 D -- -- VA 02 D -- -- NJ 105 32. Driver’s License Number 33. DOB 34. Expires 62. Driver’s License Number 63. DOB 64. Expires 04 B61409086 mm dd yy mm yy C92477807607692 mm dd yy mm yy 03/06/93 03/28 07/10/69 07/23 124 35. Owner's First Name Initial Last Name 65. Owner's First Name Initial Last Name 11 Same As Same As 125 106 Driver

Same As 125 106 Driver AWET T SEGID Driver WELLINGTON O CUMMINGS -- 11 36. Number & Street 66. Number & Street 107 1 SHERIDAN AVE 261 CAMDEN STREET 126a -- 26 37. City State Zip 67. City State Zip WEST ORANGE NJ 07052-2628 NEWARK NJ 07103-2472 126b 108 04

126b 108 04 -- 38. Make 39. Model 40. Color 41. Year 42. Plate No. 43. State 68. Make 69. Model 70. Color 71. Year 72. Plate No. 73. State NIS ROG GY 2009 J87NHD NJ TOY HIG BK 2019 W67PET NJ 126c 109 04 -- 44. VIN 45. Expires 74. VIN 75. Expires 110 JN8AS58V69W184970 01/23 5TDZZRFH5KS299502 10/22 126d 01 46. Vehicle Removed to: 76. Vehicle Removed to: -- 111 -- --

-- 126e Driven Towed Disabled Towed Disabled & Impounded Driven Towed Disabled Towed Disabled & Impounded 26 01 Left at Scene Towed Impounded Left at Scene Towed Impounded 127a 112 26 -- 47. Authority 77. Authority Owner Driver Police Owner Driver Police 127b 113 -- -- 48. Alcohol Drug Test 49. Hazardous Material 78 Alcohol Drug Test 79. Hazardous Material Given : No Yes Refused None On Board Spill Given

79. Hazardous Material Given : No Yes Refused None On Board Spill Given : No Yes Refused None On Board Spill 127c 114 -- -- Type : Breath Blood Urine -- -- Type : Breath Blood Urine -- -- Hazard Class Placard No. 127d 115 Results: 0. -- % Pending Results: 0. -- % Pending Hazard Class Placard No. -- -- 50. Carrier No. 51. GVWR / GCWR (trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only)

127e 116 USDOT -- None < 10,000 lbs. USDOT -- None < 10,000 lbs. 26 04 10,001 - 26,000 lbs. 10,001 - 26,000 lbs. MC/MX -- MC/MX -- 128 117 > 26,001 lbs. > 26,001 lbs. 26 03 52. Motor Carrier or Government Entity 82. Motor Carrier or Government Entity -- -- 129

11 Number & Street Number & Street -- -- 130 11 City State Zip City State Zip -- -- -- -- -- -- 131 135. Damage To Other Property Yes (if Yes, describe) No 10 -- 132

132 10 133 Oper. 136. Charge 137. Summons No. Oper. 138. Charge 139. Summons No. 03 -- -- -- -- -- -- 134 Oper. 140. Charge 141. Summons No. Oper. 142. Charge 143. Summons No. 03 -- -- --

03 -- -- -- -- -- -- Names & Addresses of Occupants 83 84 85 86 87 88 89 90 91 92 93 94 95 If Deceased, Date & Time of Death MENGSTAB, HENOK, 7725 BRISTOL SQUARE CT, A 1 01 01 05 29 M -- -- 01 11 04 -- -- SPRINGFIELD, VA 22153 CUMMINGS, WELLINGTON O, 261 CAMDEN STREET, NEWARK, B 2 01 01 05 52 M -- -- 01 11 04 -- -- NJ 07103-2472 C -- -- -- -- -- -- -- -- -- -- -- -- -- -- D -- -- -- -- -- -- -- -- -- -- -- -- -- -- NJTR-1 (Rev. 01/17)