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THE FOLLOWING INFORMATION IS REQUIRED FOR ALL ACCIDENTS <br />Indicate <br />North <br />by Arrow <br />INDICATE BY DIAGRAM WHAT HAPPENED <br />AGENCY CASE NO. <br />' <br />Hwy <br />281 <br />NOT <br />/ ° \ <br />i N <br />TO S■L&" <br />• <br />:DESCRIPTION OF ACCIDENT BASED ON- OFFICER'S INVESTIGATION <br />Southbound vehicle on Highway 281 struck deer on roadway near Cedarview Rd.' <br />�'. PROPERTY] <br />OBJECT DAMAGED <br />OWNER NAME ADDRESS - PHONE <br />APPROX. COST OF DAMAGE <br />OBJECT DAMAGED <br />OWNER NAME 'ADDRESS PHONE <br />APPROX. COST OF DAMAGE <br />'.S3SS3N11M <br />NAME ADDRESS <br />PHONE <br />NAME ADDRESS <br />RHONE <br />VEHICLE MOVEMENT <br />BEFORE COLLISION <br />POINT OF IMPACT AND <br />MOST DAMAGED AREA <br />(Enter numbers for each vehicle) <br />VEHICLE 1 VEHICLE 2 <br />AIRBAG DEPLOYED <br />VEHICLE 1 <br />RESTRAINT USE <br />VEHICLE 1 <br />TOTAL <br />OCCUPANTS <br />VEH <br />1 <br />001 <br />VEH <br />2 <br />VEH <br />ND. <br />N S <br />E w <br />ROAD OR <br />HIGHWAY NAME <br />ALCOHOL <br />TESTING <br />Drivel' <br />No. 1 <br />Dever <br />' No. 2 <br />Pedes- <br />trian <br />_ <br />_ <br />X <br />Hwy 281 <br />ALCOHOL <br />LEVEL <br />TESTED <br />Y <br />Y <br />4 <br />2 <br />POINT <br />MPAC <br />08 <br />POINT <br />IMIPACOF <br />2 <br />N <br />X <br />N <br />N <br />1 None used - vehic e occ ant <br />occupant <br />2 Lap & shoulder belt used <br />3 Shoulder belt only used <br />4 Lap belt only used <br />5 Child safety seat used <br />6 Child booster seat used <br />7 DOT approved helmet used <br />8 C os t ume helmet used <br />9 Restraint use unknown <br />VEHICLE 2 <br />1 Deployed front <br />2 Deployed side <br />oY <br />3 Deployed both front/side <br />4 Not deployed <br />5 Not applicable/ <br />No airbag available <br />6 Unknown <br />VEHICLE 2 <br />BAC LEVEL <br />1 <br />01 <br />06 Turning left <br />07 Making U -turn <br />08 Entering <br />traffic lane <br />MOST <br />DAMAGED <br />AREA <br />08 <br />MOST <br />DAMAGED <br />AREA <br />A DRUGSLf <br />SUSPECTED <br />Driver. <br />No. 1 <br />Driver <br />No. 2 <br />2 <br />00 None 02 1 03 i 04 <br />1 <br />01 Essentially 09 Leaving <br />Y g <br />straight ahead traffic lane <br />Backing 10 Parked <br />03 Changing lanes. 11 Slowing or <br />04 Overtaking/ stopped in traffic <br />Passing 12 Other <br />05 Turning right 13 Unknown <br />1 Neither alcohol nor drugs suspected <br />2 Ves - alcohol suspected <br />pected <br />3 Yes - drugs suspected <br />4 Yes - alcohol & drugs suspected <br />5 Unknown <br />09 Top & windows — <br />10 Undercarriage 01 <br />11 Total (at areas) _ <br />-- <br />— <br />05 <br />— <br />- <br />- <br />12 Other 08 1 07 06 <br />OFFICER NO. - <br />90826 <br />TROOP/ <br />BEAM/ <br />DEPARTMENT <br />4000 Hall County Sheriff De <br />taken9 NO <br />INVESTIGATOR NAME (Print or Type) <br />Chris Folkerts <br />INVESTIGATOR SIGNATURE <br />Digital Certificate with Nebraska Crime Commission <br />DATE OF <br />REPORT <br />05/13/2011 <br />