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

96 05 Page 1 of 3 Fatal New Jersey Police Crash Investigation Report Reportable Non-Reportable Change Report 118a 1. Case Number 11. Speed Limit 25 97 19027398 10. Crash Occurred On: MITCHELL ST - 2 5 - - - - - - - - . - - 118b 01 2. Police Dept. of Code Road Name Dir 12. Route No. 13. Milepost - 98 At Intersection with 18. Speed Limit 119a 01 WEST ORANGE 01 Feet N E VALLEY RD 2 5 3. Station/Precinct - Miles S W of: 04 99 - 14 15 16

- 14 15 16 19. To: 17. Cross Road Name/Route No. NB EB 119b 07 4. Date of Crash 5. Day of Week 6. Time 7. Municipality 8. Total 9. Total Ramp From: - SB WB 02 20 Route Name/Route No. 100a mm - O - - (use 2400 hrs.) dd yy Code KilledSu M Tu W Injured 21. Latitude 22. Longitude 120a 01 0 8 0 5 1 9 -Th -F -Sa 1 6 5 5 0 7 2 2 - - 03 - - . - - - - - - - - . - - - - - - 01 100b 23. Veh. # 24. Policy No. 25. NJ Ins. Code 53. Veh. # 54. Policy No. 55. NJ Ins. Code 120b 04 01 4596 581860 100 02 4379957691 * - 101 Parked Ped Pedalcylist Resp. to Emergency Hit & Run Parked

* - 101 Parked Ped Pedalcylist Resp. to Emergency Hit & Run Parked Ped Pedalcylist Resp. to Emergency Hit & Run 121a 02 26. Driver's First Name Initial Last Name 29. Sex 56. Driver's First Name Initial Last Name 59. Sex 01 102 HADIYAH M HILL F VALENTINO - ADAMES-RENE M 121b 01 27. Number & Street 57. Number & Street - 103 40 HAMPTON TERRACE 127 FOSTER ROAD 01 28. City State Zip 58. City State Zip 104 ORANGE NJ 07050 ROCHESTER NY 14616 122 02 30. Eyes

122 02 30. Eyes DL Class Restrictions Endorsements 31. State 60. Eyes DL Class Restrictions Endorsements 61. State 0 2 D- - - - - - - 0 2 D- - - - - - - 01 NJ NY 123 105 32. Driver's License Number 33. DOB mm dd yy 34. Expires mm yy 62. Driver's License Number 63. DOB mm dd yy

64. Expires mm yy 01 03 H4350 31174 579 0 7 0 6 9 6 0 7 2 2 96422 5169 0 2 1 4 9 5 0224 35. Owner's First Name Initial Last Name 65. Owner's First Name Initial Last Name 106 124 Same as Same as - Driver Driver 11 107 36. Number & Street 66. Number & Street

66. Number & Street 125 - - - 08 108 37. City State Zip 67. City State Zip 126a 01 - - 26 109 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 126b 05 DODGE AVE SL 2012 G11LNE NJ CHEVROLETPICKUP RD 2015 HVL1741 NY - 110 44. VIN 45. Expires 74. VIN 75. Expires 126c 01 1 C 3 C D Z A B X C N 2 2 7 4 8 6 07/20 1 G C V K R E C 7 F Z 2 1 7 4 4 4 11/19 - 111

126d 46. Vehicle Removed to: 76. Vehicle Removed to: 01 SELECT TOWING SELECT TOWING - 112 126e Driven Towed Disabled Towed Disabled & Impounded Driven Towed Disabled Towed Disabled & Impounded - Left at Scene Towed Impounded Left at Scene Towed Impounded 26 113 127a 47. Authority 77. Authority - Owner Driver Police Owner Driver Police

er Police Owner Driver Police 26 114 127b 48. Alcohol Drug Test 49. Hazardous Material 78. Alcohol Drug Test 79. Hazardous Material - Given: No Yes Refused None On Board Spill Given: No Yes Refused None On Board Spill - 115 Type: Breath Blood Urine Type: Breath Blood Urine 127c - - - - - - - - - - - - 116 Results: 0. - - % Pending Hazard Class Placard No. Results: 0. - - % Pending Hazard Class Placard No. 127d 01 50. Carrier No. 51. GVWR / GCWR (trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only)

(trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only) 10,000 lbs. 10,000 lbs. - 117 USDOT - - - - - - - None USDOT - - - - - - - None 127e 10,001 - 26,000 lbs. 10,001 - 26,000 lbs. 04 MC/MX - - - - - - - 26,001 lbs. MC/MX - - - - - - - 26,001 lbs. 26 128 52. Motor Carrier or Government Entity 82. Motor Carrier or Government Entity - -

- 26 129 Number & Street Number & Street - - 12 130 City State Zip City State Zip - - - - - - 12 131 135. Damage to Other Property Yes (If Yes, describe) No -