314-24 Attachment.pdf

96 118a 05 97 01 1 Page 2 of 1. Case Number 06 99 07 WEST ORANGE 02 102 02 103 02 104 02 105 00 106 00 Feet Miles 50 4. Date of Crash mm dd yy THU 02/03/22 1721 0722 02 00 109 01 110 00 0 115 -- -- EB SB WB 134 Parked Ped Pedalcyclist Resp. to Emergency 954014143 Hit & Run Parked Ped 25 -120a 00 120b 55. NJ Ins. Code Pedalcyclist -121a Resp. to Emergency Hit & Run 26. Driver's First Name Initial Last Name 29. Sex 56. Driver's First Name Initial Last Name 59. Sex -- -- -- -- -- -- -- -- -121b -- HIT & RUN 27. Number & Street 57. Number & Street -- -- 122 28. City State Zip 58 City State Zip -- -- -- -- -- -- 00 30. Eyes DL Class Restrictions Endorsements 31. State 60. Eyes DL Class Restrictions Endorsements 61. State -- -- -- -- -- 02 -- -- -- -- 33. DOB mm dd yy 34. Expires mm yy 62. Driver’s License Number -- -- 32. Driver’s License Number ** 35. Owner's First Name Same As -Driver 36. Number & Street Initial Last Name ** 65. Owner's First Name Same As NICOLE C CHIRICO Driver 66. Number & Street 63. DOB mm dd yy 64. Expires mm yy -- -- Initial Last Name State Zip -- -- WEST ORANGE Zip NJ 07052-2302 40. Color 41. Year 42. Plate No. 43. State 68. Make 69. Model 70. Color 71. Year 72. Plate No. 73. State -- -- -- -- -- MAZDA 3 WT 2018 NJ 44. VIN 45. Expires 74. VIN 75. Expires -- -- 3MZBN1V39JM249945 05/22 126b -126c -126d -- 76. Vehicle Removed to: Driven Towed Disabled Left at Scene Towed Impounded Towed Disabled & Impounded 47. Authority 126e Driven Towed Disabled Left at Scene Towed Impounded Towed Disabled & Impounded Yes Breath Police Refused Blood % 49. Hazardous Material None On Board Urine Pending Owner 78 Alcohol Drug Test Given : No Spill Type : -- -- Hazard Class Placard No. 51. GVWR / GCWR (trucks & buses only) USDOT -- None MC/MX -- 117 Driver Yes 26 Breath Blood 0. -Results: 80. Carrier No. < 10,000 lbs. USDOT -- 10,001 - 26,000 lbs. MC/MX -- % 127b Police Refused Urine Pending 79. Hazardous Material None On Board -Spill -- -- Hazard Class Placard No. 81. GVWR / GCWR (trucks & buses only) None < 10,000 lbs. > 26,001 lbs. -- -- Number & Street Number & Street -- 28 00 130 -State Zip City State Zip -- -- -- -- -- -- Yes

acard No. 81. GVWR / GCWR (trucks & buses only) None < 10,000 lbs. > 26,001 lbs. -- -- Number & Street Number & Street -- 28 00 130 -State Zip City State Zip -- -- -- -- -- -- Yes (if Yes, describe) -127e 129 City 135. Damage To Other Property -127d 128 > 26,001 lbs. 82. Motor Carrier or Government Entity 127c 26 10,001 - 26,000 lbs. 52. Motor Carrier or Government Entity 28 127a 77. Authority Driver 48. Alcohol Drug Test Given : No 00 V34NUX -- 0. -Results: 50. Carrier No. 11 28 State 39. Model Type : 124 11 38. Make 46. Vehicle Removed to: 10 126a 67. City -- 123 125 721 PLEASANT VALLEY WAY 37. City 116 01 22. Longitude -- NB 02 113 00 21. Latitude 119a 119b 53 Veh. # 54. Policy No. -- Owner 114 25 * 112 -- -- -13. Milepost 18. Speed Limit 25. NJ Ins. Code 01 00 -Suffix 01 -- 111 -12. Route No. 17. Cross Road Name/Route No. -To: 20. Route Name/Route No. From: 19. Ramp 06 118b 23. Veh. # 24. Policy No. -- 108 9. Total Injured -- -- 107 Change Report MT. PLEASANT PL. Of : E S W 16. 7. Municipality 8. Total Code Killed 15. 6. Time (use 2400 hrs.) 5. Day of Week Non-Reportable 25 Dir N 14. 100b 101 01 -- 01 S BROOK PLACE Road Name At Intersection with 3. Station/Precinct 100a 04 Code Reportable 11. Speed Limit 10. Crash Occurred On: 2022-001809 2. Police Dept. of 98 New Jersey Police Crash Investigation Report Fatal No 00 131 09 132 -- 09 Oper. 136. Charge 137. Summons No. Oper. 138. Charge 139. Summons No. -- -- -- -- -- -- Oper. 140. Charge 141. Summons No. Oper. 142. Charge 143. Summons No. -- -- -- -- -- -Names & Addresses of Occupants If Deceased, Date & Time of Death 83 84 85 86 87 88 89 90 91 92 93 94 95 A -- -- -- -- -- -- -- -- -- -- -- -- -- -- B -- -- -- -- -- -- -- -- -- -- -- -- -- -- C -- -- -- -- -- -- -- -- -- -- -- -- -- -- D -- -- -- -- -- -- -- -- -- -- -- -- -- -- NJTR-1 (Rev. 01/17) 133 00 134 03