Mv4017 Form PDF Details

Are you filing taxes for the first time and feeling overwhelmed with all of the different forms? You’re not alone! Many people struggle to make sense of the tax filing process. One form that you may come across is called an Mv4017, but it can be hard to understand exactly what this form is used for and how it applies to your individual situation. In this blog post, we will break down everything you need to know about an Mv4017 form so that you can confidently navigate tax season!

QuestionAnswer
Form NameMv4017 Form
Form Length15 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min 45 sec
Other namesDOLSEN, WASHINGTON, U-Haul, 1993

Form Preview Example

You Are Notified to Appear

Date

 

Time

 

 

Form No. and Version CTL

CITATION NO.

 

 

 

 

APR-07-2010

08:30 AM

 

 

MV4017

0901

N168141 -

1

Appearance Required:

NO

 

 

 

 

 

Estimated Points

DEPOSiT

Cash - Card

 

 

 

 

 

 

 

 

 

MADISON CITY MUNICIPAL COURT

 

 

 

 

 

6

 

$364.50

N

N

 

 

 

 

 

 

 

 

 

 

210 MARTIN LUTHER KING JR BLVD RM 203

 

 

 

 

Court Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MADISON,

WI

53703

 

 

 

 

 

 

 

 

 

 

 

 

Defendant(Last Name. First. Middie). Street Address. P.O. Box, City. State. Zip

Birth Date

Sex

Race

 

 

 

 

 

 

 

 

 

10/8/1976

 

M

W

 

OKAFO JEFF A

 

 

 

 

 

 

 

 

 

 

 

 

 

910 MAGNOLIA LANE 3

 

 

 

 

 

 

HT

WT

 

Hair

Eyes

 

MADISON,

WI

53713

 

 

 

 

 

 

600

280

lbs

BLK

BRO

Driver License/Identification Card Number

 

State

Exp. Yr.

 

License Class

License Endorsements

 

02104217636807

 

 

WI

2010

 

D

 

 

 

 

 

 

License Plate Number

Plate Type

State

Exp. Yr.

OPERATING AS:

 

 

 

 

 

FJ8471

 

 

LTK

 

WI

2010

 

DRIVER

 

 

 

 

 

 

Vehicle Identification Number

US DOT No.

 

Hazmat No.

 

Vehicle Class

Vehicle Endorsements

 

IGCEC14Z4PEI06654

 

 

 

 

 

D

 

 

 

 

 

 

Vehicle Year

 

Make

Type

 

Color

 

CMV

 

CDL Waiver

 

 

 

1993

 

CBEY

PK

 

SIL

 

 

N

 

 

 

 

 

 

Plaintiff

 

 

 

Ordinance Violated

 

 

 

Adopting State Statute

 

CITY OF MADISON

 

 

 

 

 

 

 

 

346.67 (1) (a)

 

Violation Description

 

 

 

BAC

 

OvelWeight

 

Agency Space

 

 

 

 

 

 

 

 

 

 

 

 

 

HIT AND RUN

 

 

 

 

 

 

 

 

 

 

 

 

 

Week Day

 

Date

Time

 

Actual Speed Legal

 

Over

 

2010-25036

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEDNESDAY

 

JAN-13-2010

03:04 AM

 

 

 

 

 

 

 

 

 

 

County

 

 

CityNiliagefTown

 

 

 

 

 

 

 

 

 

DANE - 13

 

MADISON - 73,

CITY

 

 

 

 

 

 

 

 

ON Hwy No. and/or Street Name

 

 

 

 

Estimate Distance

 

 

 

 

 

W WASHINGTON AVE

 

 

 

 

 

 

 

 

 

 

 

 

From/AT Hwy No. and/or Street Name

 

 

 

GPS Coordinates

 

 

 

 

 

 

 

 

 

 

 

Minor Passenger

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UlIAUL

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer Name

 

 

 

 

 

Zone: RR

Utmty

w School -

Const

Accident Severity

 

PO CHANDA DOLSEN

 

 

 

N

 

N

N

N

PROP DAMAGE

 

Officer ID

Department

 

 

 

 

 

Date Citation Served,

Method

 

 

3896

MADISON POLICE DEPARTMENT

 

 

 

MAR-06-2010

 

IN PERSON

 

Lanes

 

Road Condition

 

POLICE RECORD

---cT"'=a"ff=ic------.L"ig"'h=t'C"o"n"'di"'ti"on=-----

 

 

UNKNOWN

 

 

 

 

 

L -

LIGHT

 

DARK-LIGHTED

 

Highway

 

 

 

 

 

 

Weather Condition

 

 

 

 

 

PARKING-LOT-OR-PRIVATE-PROPERTY

 

 

 

CLEAR

 

 

 

 

 

 

PLEASE REFER TO CASE 2010-25036

T331 9/2001 WDOT

s345.11 Wis. Stats

WISCONSIN UNIFORM CITATION

YQU Are Notified to Appear

Date

 

Time

 

 

Form No, and Version CTL

CITATION NO.

 

 

 

 

APR-07-2010

08:30 AM

 

 

MV4017

0901

N168142 -

2

Appearance Required:

YES

 

 

 

 

Estimated Points

DEPOSIT

Cash - Card

 

 

 

 

 

 

 

 

 

MADISON CITY MUNICIPAL COURT

 

 

 

 

3

 

$264.50

N

N

 

 

 

 

 

 

 

 

 

 

210 MARTIN LUTHER KING JR BLVD RM 203

 

 

 

 

Court Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MADISON,

WI

53703

 

 

 

 

 

 

 

 

 

 

 

 

Defendant<Last Name, First, Middie), Street Address, P,O, Box, City, State, Zip

Birth Date

Sex

Race

 

 

 

 

 

 

 

 

 

10/8/1976

 

M

W

 

OKAFO JEFF A

 

 

 

 

 

 

 

 

 

 

 

 

 

910 MAGNOLIA LANE 3

 

 

 

 

 

 

HT

WT

 

Hair

Eyes

MADISON,

WI

53713

 

 

 

 

 

 

600

280

lbs

BLK

BRO

Driver License/Identification Card Number

State

Exp, Yr.

 

License Class

License Endorsements

 

02104217636807

 

 

WI

2010

 

D

 

 

 

 

 

 

License. Plate Number

Plate Type

State

Exp. Yr.

 

OPERATiNG AS:

 

 

 

 

 

FJ8471

 

 

 

LTK

WI

2010

 

DRIVER

 

 

 

 

 

 

Vehicle Identification Number

 

US DOT No.

Hazmat No.

 

Vehicle Class

Vehicle Endorsements

 

lGCEC14Z4PE106654

 

 

 

 

 

D

 

 

 

 

 

 

Vehicle Year

 

Make

Type

Color

 

 

CMV

 

COL Waiver

 

 

1993

 

CHEV

 

PK

SIL

 

 

N

 

 

 

 

 

 

Plaintiff

 

 

 

Ordinance Violated

 

 

 

Adopting State Statute

 

CITY OF MADISON

 

 

 

 

 

 

 

 

343.44(1) (b)

 

Violation Description

 

 

 

BAC

 

OveIWeight

 

Agency Space

 

 

 

 

 

 

 

 

 

 

 

 

 

OPERATING AFTER REVOCATION

(2ND)

 

 

 

 

 

 

 

 

 

 

Week Day

 

Date

 

Time

Actual Speed Legal

 

Over

 

2010-25036

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEDNESDAY

 

JAN-i3-20iO

 

03:04 AM

 

 

 

 

 

 

 

 

 

 

County

 

 

 

CityNiliagerrown

 

 

 

 

 

 

 

 

 

DANE - 13

 

 

MADISON

- 73,

CITY

 

 

 

 

 

 

 

 

ON Hwy No. and/or Street Name

 

 

 

 

Estimate Distance

 

 

 

 

 

W WASHINGTON AVE

 

 

 

 

 

 

 

 

 

 

 

 

From/AT Hwy No. and/or Street Name

 

 

GPS Coordinates

 

 

 

 

 

 

 

 

 

 

Minor Passenger

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UHAUL

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer Name

 

 

 

 

Zone: RR Utility

MSchool - Canst

Accident Severity

 

PO CHANDA DOLSEN

 

 

 

N

 

N

N

N

PROP DAMAGE

 

Officer 10

Department

 

 

 

 

 

Date Citation Served,

 

Method

 

 

3896

MADISON POLICE DEPARTMENT

 

 

 

MAR-06-2010

 

 

IN PERSON

 

Lanes

 

Road Condition

 

POLICE RECORD

Traffic

Light Condition

 

 

 

 

 

 

 

 

 

UNKNOWN

 

 

 

 

 

L -

LIGHT

 

DARK-LIGHTED

 

Highway

 

 

 

 

 

 

Weather Condition

 

 

 

 

 

PARKING-LOT-OR-PRIVATE-PROPERTY

 

 

 

CLEAR

 

 

 

 

 

 

PLEASE REFER TO CASE 2010-25036

T331 9/2001 WDOT

s345.11 Wis. Stats

WISCONSIN UNIFORM CITATION

 

MADISON POLICE DEPARTMENT

Date of Report:

3/8/2010

Case No:

2010-25036 Field Arrest

 

 

Ref. No:

 

Occurred Incident:

52 - Accident - Hit & Run

Sec/Area:

404 CENTRAL

Dispatched as:

52 - Accident - Hit & Run

Grid:

CAPITOL

Case Offense:

ARRESTED PERSONIHIT AND RUN

 

Addr of Occurrence:

602 W Washington Av

 

 

Call DatelTime:

01/28/201010:36

From DatelTime:

Dispatch DatelTime:

01/28/2010 10:50

Thru DatelTime:

Reporting Officer:

PO CHANDA M DOLSEN 3896

 

 

Special Routing:

PO CHANEY, POTREVARTHEN, LT MCCAW, VENDING (CITY CLERK)

SUSPECT

JEFF A. OKAFO

'ARRESTED

 

MIS DOB: 10108/76 (33 yrs) Height: 6.00 Weight: 280

 

HairColor: BLK EyeColor: BRO

 

 

910 MAGNOLIA LA 3 MADISON WI

H: 608-239-4186 W: 347-5417 2133 C: 608-

 

239-4186

 

DRV L1C:

0210-4217-6368-07 WI

 

OFFENSE #1: HIT AND RUN: PDO (PR, S 346.67(1)

OFFENSE #2: OPERATING AFTER REVOCATION, S 343.44

OFFENSE #3: VENDING RESTRICTION, C 9.13(4)

VICTIM

JOHN P. HANDLEY

 

MIW DOB: 08/12/55 (54 yrs) Height: 5.10 Weight: 200

 

HairColor: BRO

EyeColor: BRO

 

4705 GRANDVIEW CT MCFARLAND WI H: 608-838-6489 C: 608-334-1361

CONTACT

JAMES DAVIS

 

 

MIB DOB: 09/28/68 (41 yrs) Height: 5.08 Weight: 230

 

HairColor: BLK

EyeColor: BRO

 

8646 GREENWAY BL 202 MIDDLETON WI H: 444-1590 W: 577-4857 C: 608-444-

 

1590

 

DRV L1C:

D120-4406-8348-03 WI

PROPERTY INFO:

 

Code

Description

Value

ACCIDENT UNK YR CHEV TRK GRY

 

CHEV CHEVROLET

 

SIN: UNK

License

 

Owner: JEFF A. OKAFO (SUSPECT)

DAMAGED

FOOD CART

$200.00

 

Owner: JOHN P. HANDLEY (VICTIM)

SUSP VEH: 1993 CHEVROLET ChevyTruck (TRUK 1993) Lie Num: FJ8471-Wisconsin 1993 SILVER PICKUP TRUCK WISCONSIN REGISTRATION SILIWHTGLD Truck

NARRATIVE:

On 01-28-2010 I was dispatched to 602 W. Washington Avenue, the U-Haul store, in reference to a hit and run. Upon my arrival I met with the complainant identified by Wisconsin Driver's License as John Handley. Handley told me he stores his food cart, the FIBS cart, in the U-Haul parking lot. On

Case # 2010-25036, PO CHANDA M DOLSEN 3896

Page 2 of4

01-13-2010 Handley observed damage to his cart. The U-Haul store manager retrieved video surveillance showing the damage occurred from another vehicle unsafely backing a food cart.

The footage was taped on 01-13-2010 at approximately 3:04 AM. I reviewed the video with Handley and the store manager. The video showed a silver pickUp truck backing the JD's food cart. I could see the JD's cart strike the FIBS cart. The video clearly showed the FIBS cart forcefully slide backwards. After the damage occurred the driver exited the vehicle as if he was checking for damage.

The driver pulled forward several times, finally parking the JD's cart next to the FIBS cart. He unhooked the cart and exited the parking lot. He did not leave a note or make any attempt to contact the staff at U-Haul to report the damage. I retrieved the video footage and still photos. All were submitted as evidence.

I observed damage on the front corner of the FIBS cart. Handley told me he called the owner of the JD food cart, James Davis. Handley said Davis was not the driver of the silver pickup, it was his "employee". Davis told Handley he would talk to his employee and get back with him. Davis never called Handley back. This is when Handley contacted the police to file a report.

I gathered Handley's personal information and cart information for my report. Handley advised he had received a verbal estimate of $200.00 to repair the damage. Handley told me he never gave anyone permission/consent to damage his property and Handley is willing to pursue a criminal complaint. I provided him with my business card including the case number and my contact information.

I contacted James Davis via telephone. Davis told me he was not the one that had returned his cart to the U-Haul lot that night. He initially told me it was an employee, then he said it was Jeff Okafo. Davis said after he had been contacted by Handley he called Okafo to question him. Davis said Okafo admitted to hitting the FIBS cart but Okafo didn't think he caused much damage. Davis said Okafo agreed to contact Handley to make arrangements to pay for the damage. Davis told me he was under the impression Okafo contacted Handley until I called him. Davis provided me with a cell phone number for Okafo. I contacted Okafo via telephone. Okafo told me he was doing Davis a favor by taking his cart to the U-Haullot. He admitted he backed the cart and said, "I thought I might have hit the FIBS cart but I am not sure". Okafo then said, "I thought I hit that trailer but I didn't see it

move."

Okafo then became very irritated with me asking him questions. He asked me why Handley didn't call him. Okafo said he doesn't feel it was his responsibility to report the hit and run, and thought Handley should have contacted Okafo. I asked Okafo to provide me with his vehicle information. He told me he was at work and he didn't have it accessible. Okafo said he would get the vehicle information and call me back.

I spoke with Okafo two more times. after that initial conversation requesting he provide me with his vehicle information. He never returned my call or prOVided his vehicle information. Further investigation showed Okafo's driver's license is revoked. I completed two tracs citations. The first citation #N 168141-1 for the Hit &Run and the second citation #N 168142-2 for Operating After Revocation. I went to his address mUltiple times attempting to serve him his citations. I had no success contacting anyone and I was hesitant to leave the citations under his door or send them certified.

On 02-06-2010 I was assigned to work the Vigil for Life rally in the 700 block of State Street. When I reported to the area I noticed the Jin's Chicken Food Cart was abandoned with no vendors present.

Case # 2010-25036, PO CHANDA M DOLSEN 3896

Page 3 of 4

Per City of Madison Ordinance 9.13 there is No Storage of Vending Equipment without a Vendor Present. I completed a Municipal Citation #A0317793 and requested a case number be drawn to document the violation 2010-36124. At this point I still was having trouble contacting Okafo.

On 03-06-2010 while working in my neighborhood I observed the Jin's Chicken Food Cart abandoned in the 700 block of State Street with no vendors present. Per City of Madison Ordinance 9.13 there is No Storage of Vending Equipment without a Vendor Present. I completed a Municipal Citation #A067065 and requested a case number be drawn to document the violation 2010-59847.

At approximately 11 :00 AM this morning PO R. Hennessey and I went to 910 Magnolia #3 to serve Okafo the four citations. After several minutes of knocking Okafo came to the door. I introduced myself verbally and explained to him why I was there. I presented him with the four citations; Hit & Run, OAR, and No Storage of Vending Equipment without Vendor Present X2. I pointed out the court date, time and the location on all the citations. Okafo didn't have much to say and asked no questions. Okafo did mumble something under his breath about him getting citations for leaving his cart abandoned. He then shut his door. NFA/jrl

Supervisory Officer:

1.0.:

_

RepOl'!irg .officer: "

1.0.: 3896

 

 

PO CHANDA M DOLSEN

 

'(IIiSCQ-J;lSin Motor Vehicle 9BSLK45 Ulil 0INAl Page

Accideftt Report MV4000e 01/2005

050206

 

 

 

 

 

 

DOT Document Number

 

 

 

ｾ Reportable Accident

o On Emergency o Amended 9BSLK45

 

 

 

Agency Accident Numbe'r

 

Police Number

\.l)

 

 

CENTRAL

 

 

2010·25036

 

 

4 • Accident Date

 

 

 

CVJ

 

 

 

 

 

 

 

01/1312010

 

 

 

tel

'"

 

 

 

 

 

 

 

 

 

 

 

It.J

'"

 

 

 

 

 

on

 

 

 

 

 

 

C>

 

 

 

 

 

C'(

"!

 

 

 

 

 

ｾ

 

 

 

 

 

 

C>

 

 

 

 

 

I

C>

 

 

 

 

 

N

Z

 

 

 

 

 

 

 

 

 

ｾ

 

16 • FrfAI Hwy No.

 

 

 

 

0

 

 

 

 

.....-.., w

 

 

 

 

j::

 

 

 

 

 

"

 

 

 

 

 

0

«

17· Structure Type

17 - Structure Number

13 - Longitude

 

:::;

 

0

:;;

 

 

 

 

 

0-

n::

80 - Firs! Harmful Evenl

 

 

93 - Manner of Collision

 

 

0

 

 

 

 

IJ..

OTHER OBJECT·· NOT FIXED

NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT

 

 

a:

 

 

oJ

112· Access Control

 

113 - Road Curvature

Surface Type

 

 

NO CONTROL

 

 

ASPHALT

 

 

ｾ

 

 

 

 

W

115-TrafficWay

 

 

 

 

 

 

 

 

 

ZPARKING·LOT.OR·PRIVATE·PROPERTY

W

Cl 117 - Relation To Roadway

PARKING·LOT·OR-PRIVATE-PROPERTY

-'

114 - light Condition

Ol

DARK-NOT·LIGHTED

>-

z

 

w

 

0

 

"

 

 

 

9

 

>-

 

 

 

o Names Exchanged

z

 

 

 

w

 

 

 

c

 

 

 

79- EM SNumber

<3

 

 

 

 

 

 

o

 

0

 

 

 

 

«

 

 

 

 

 

Operator/Pedestrian

 

 

 

 

 

Unit Status

181 - Most Harmful Event: Collision With

123 -. Djr Of Travel I 24· Speed limit

H - HIT AND RUN

 

OTHER FIXED OBJECT

 

EAST

I NIA

36 - Operating as Classified

137 -Endorsements

135

 

 

o CLASS

 

0

Operating Commercial Motor Vehicle

C

/

z

S

ｾw

o

W

J0-

D:

ｾ

W

0-

o

26· Address Stre€t & Number

 

 

 

 

 

126 - PO Box

5134 CURRY COURT 3

 

 

 

 

 

 

27· City

 

 

 

127 ｾ State 127 -Zip Code

128. Telephone Number

FITCHBURG

 

 

 

WI

 

53713

(608)239-4186 EXT.

39 ｾ Seat Position

 

 

 

 

 

/40. Safety Equipment

FRONT-SEAT·LEFT-SIDE-(MC/BIKE DRIVER. TRAIN CONDUCTOR)

RESTRAINT·USE·UNKNOWN

38 - Injury Severity

 

141 - Airbag

 

142 "Ejected

I"

N - NO APPARENT INJURY

 

NON·DEPLOYED

 

NOT-EJECTED

0 Medical Transport

43 _ Trapped/Extricated

 

192. Pedestrian location

192. PedeSlrlan Action

 

NOT-TRAPPED

 

 

 

 

 

 

IｾＲ ｾ No. of Citations Issued

119 • Itvtlat Driver Was Doing

 

1120 -Traffic Control

 

 

BACKING-MANEUVER

 

NO-CONTROL

 

I64· 4th Statute No,

I64 - 5th Statute No.

64 ｾ 1st Statute No.

164. 2nd Statute No,

164 -3rd Statute No.

 

346.67(1)(A)

341.03(1)

 

 

 

 

 

122 - Driver Factors

 

 

 

 

 

 

 

UNSAFE-BACKING

 

 

 

 

 

 

 

88· Driver or Pedestrian Factors 189 -Substance Presence

 

 

 

 

NOT OBSERVED

 

UNKNOWN

 

 

 

 

90 ｾ Alcohol Test

 

 

190 -Alcohol Content

 

91 ｾ Drug Test

 

TEST NOT GIVEN

1 TEST-NOT-GIVEN

Wisconsin MotorVehicle

9BSLK45

Page

2 of 4

 

,>

Accident Report MV4000e 0112005

 

 

050206

 

 

 

91 ｾ Drugs Reported

 

 

 

124· Highway Factors

 

 

 

NOT-APPLICABLE

 

 

 

Vehicle

21 " Unit Type

I Vehicle Type

1 22 • Total occupants

TRUCK

UTILITY-TRUCK

1

 

95 • Extent Of Damage

96

197 .Vehicle Removed By

 

NONE

1 o Vehicle Towed Oue To Damage

 

OPERATOR

 

123· Vehicle Factors

 

 

 

 

NOT-APPLICABLE

 

 

 

 

Vehicle Owner

 

 

 

 

45

 

 

 

ｾ

1ZI ｖ･ｨｩ｣ｬｾ Owner Same As Operator

 

IｾＶＧ Middle Initial I46· Suffix

0

46 • Vehicle Owner Last Name

1 46· First Name

 

 

 

0:

OKAFO

JEFF

 

 

 

 

 

 

W46 • Company Name

Z

 

 

 

 

S

 

 

147. POBox

 

0

47'- Address Street & Number

 

 

:I:

5134 CURRY COU RT 3

 

 

 

W

FITCHBURG

 

ｲｾｉｓｴ｡ｴ･ I 53713

(608) 239-4186 EXT,

>

 

 

48· City

 

48 - lip Code

149. Telephone f'!umber

 

Insurance

 

 

 

 

 

.,

-10 Policy Holder Same As Owner

J

63 ｾ liabllity Insurance Company

 

NO INSURANCE

 

ｾ

 

0

61 • Policy Holder last Name

 

I61.' Policy Holder First 'Name

..

(/)

 

 

 

 

 

 

ｾ61 - Policy Holder Company

 

School Bus

ISchool Name

IBody Make

 

ｾ Bus Travelling to/from

! seating Capacity

0

o To 0 From

 

 

 

(/)

 

 

 

School District Contracted With

 

 

::::>

 

 

 

 

 

 

lD

 

 

 

 

/

Property

 

 

 

 

Organization Type -

I 84· Properly Owner Last Name

I84 - First Name

1 ｾ - Middle Initial I 84 - Suffix

 

INDIVIDUAL

HANDLEY

.

JOHN

 

\J

V,)iisco!,!sin Motor Vehicle

9BSLK45

 

 

Page

3 of 4

 

 

 

 

Acciilerft Report MV4000e 01/2005

 

 

 

 

 

050206

 

 

 

 

 

IGovernment Property TYPE

 

84 " Company Name

 

 

 

 

 

 

 

 

 

 

....

85" Address Street & Number

 

 

85· PO Box

 

 

0

4705 GRANDVIEW COURT

 

 

 

I87· Telephone Number

a::

 

186. Stale

 

86 - City

 

 

86· Zip Code

W

 

 

 

 

Z

MCFARLAND

 

 

WI

53558

 

(698) 838-8489 EXT,

3:

83 • Government Damage Tag Number

 

 

 

 

0

 

 

 

 

 

 

 

>ｾ- Fixed Objects Struck

 

 

 

 

 

w

82 - Striking Unit

82" Object Struck

 

82 - Striking Unit

82 • Object StruCk

0.

1

OTHER-OBJECT-NOT-FIXED

 

 

 

 

.0ｾ.

 

 

 

 

82 - Striking Unlt

82 • Object Struck

 

82 - Striking Unit

82· Object Struck

 

82 - Striking Unit

82 - Object Struck

 

82 - Striking Unit

82 • Object Struck

Diagram and Narrative

105 • PHOTOS BY

w

>

i=

«

a::

a::

«

z

0

Z

«

::!:

ｾ

Cl

«

0

-

 

Ｎｾ

 

ｾｾｵｮｩｬｬｾ｣Ｚｊｉｊ､

 

 

[Non-Fixed Object

 

 

-

 

 

-

 

 

-

2010-25036

Pafking lol of U-Haul

Private Parking lol

PO eM. Dob.en

Diagram Not To Scale

THE EQUIPMENT IS A FOOD CART THAT WAS LEGAllY PARKED, THE EQUIPMENT IS HOMEMADE WITH NO VIN NUMBER OR REGISTRATION PLATE REQUIRED.

UNIT 1 VEHiCLE INFORMATION IS NOT COMPLETE. DRIVER 1 REFUSED TO PROVIDE THIS INFORMATION TO ME. UNIT 1 DRIVER WAS BACKING IN THE PRIVATE LOT OF 602 VVEST WASHINGTON AVE WHEN HE BACKED INTO THE EQUIPMENT (THE HOMEMADE FOOD CART OWNED BY HANDLEY) CAUSING DAMAGE. NFA

Witness

ｾ

107· Witness las! Name

1107 ｾ First Name

1'07 -Middle Initial

 

 

 

0

.

 

1'09 -

(J)

108 -Address Streeet & Number

108 - PO Box

(J)

Date of Birth

 

 

W

 

Stale 1'10. Zip Code

1111 .Telephone Number

l -

 

Z

liD-City

 

 

 

 

 

§

 

WI

 

Officer Information

Wisconsin Motor Vehicle

9BSLK45

 

 

 

Page

4

of 4

"'"' ' .."

 

 

 

 

 

 

Accident Report MV4000e 01/2005

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

050206

 

1125. First Name

I

 

Middle loilial

f31 • Officer ID

 

 

ｾＲＵﾷ Officer Last ｎ｡ｭｾ

ｾＵＧ

 

 

DOlSEN

CHANDA

 

 

 

 

3896

 

Z 129· Law Enforcement Agency No. 1130. law Enforcement Agency Name

 

 

 

 

 

 

0

314

MADISON POLICE DEPARTMENT

 

 

 

 

 

 

;::

 

 

 

 

 

 

 

 

 

«

126 • law Enforcement Agency fl.ddress Street & Number

 

 

 

 

 

 

 

ｾＮ

211 S CARROll ST

 

 

 

 

 

 

 

 

a::

127· City

j127 ".State

[127. lip Code

1128 -Telephone Number

 

0

 

U.

MADISON

WI

53703

 

 

(608) 266-4072 EXT.

 

Ｎｾ

 

 

 

a::

132 • Date Notified

]133 - Time Notified (Military Time)

134 • Time Arrived (Military Time}

1135 -Date Of Report

 

01/28/2010

1040

1050

 

 

 

01/28/2010

 

W

 

 

 

 

0

Ag'ency Accident Number

IPolice Number

19 • Special Study

 

 

 

 

 

 

ii:

 

 

 

 

 

 

CENTRAL

 

 

 

 

 

 

 

U.

2010·25036

 

 

 

 

 

 

 

018 • Agency Space

2010-25036

R.N

::l

m

ｾ

0

::l

'0::

I-

Truck and Bus

'36

 

 

 

'36

 

 

o A truck with at least two axles and six tires

o A truck with a hazardous materials placard

'36

 

 

 

 

 

 

LJ A bus designed to carry 16 or more persons. including the driver

 

 

136

1136 .

136

 

 

 

1 o Towed

 

 

 

o Fatallnjury

0

Medical Transport

 

 

 

Unit Number

 

 

 

 

 

 

137 • Hazardous Materials Class Numbers

 

 

 

 

137 - Hazardous Materials "UN" N0S'l'

 

 

 

 

 

 

Hazardous Material Placard Displayed o IHazardous Cargo Was Released 0

137 - Name Of Hazardous Materials in this Load

1137 - Name Of Hazardous Materials Released

138

 

0\ '40-US DOT No.

1140 .ICC MC No.

1 LC No.

IIC No.

1141 - ｓｯｵｲ｣ｾ

Interstate Carrier

 

 

 

 

 

139· Carrier Name

 

 

 

 

 

 

142 - Carrier Address

 

I' City

 

I Slate 1 Zip Code

 

 

 

 

143 - GVWR (Lbs)

1144. Total No. of Axles

1145 - Vehicle Configuration

 

1147 - Cargo Body Type

146" First Event

 

 

 

146 - Second Event

 

146 - Third Event

 

 

 

146 - Fourth Event

-

 

 

 

 

Printed by: Josh Marefke

Wednesday, January 20,2010 2:19:32 PM

Title: Bitmap1.bmp : uhaul

Page 1 of 1

We,dnesclay, January 20,

Madison ｾＬＱＡＮｯｬｩ｣･

Department

 

 

-2';0:5'0

IF10l0Sl

Message Display

 

2/lff/10

 

 

 

Cf'hS"ML-

 

 

 

 

 

 

 

 

 

F3=Exit

F7==Previous F8=l'lext

:F21==1>rint

 

Unit:

/01736004

8260111

 

 

WI013 0lC4

 

 

DOT

301790

12

02/18/10

15:46

01 OF 01

 

 

INP

ｉｮｰｾｴ

Request:

 

 

 

 

 

INPl

Plate: FJ8471

Type: TRK

02/18/2010 03.46

PM CT

 

INP2

Response

1 of

1

 

 

 

 

PLT Plate Information:

PLT1 NBR: FJ8471 / Type: LTK ｾＮ LIGHT TRUCK

REG Registration Information:

REGI Type: LIGHT TRUCK / Last Updated: 01/22/2010 at 08:54 AM

REG3 Period: ANNUAL / Expires: 03/31/2010

REG4 Carrier: none / VEH GRS WT: 6000LB

OWN Owner Detail:

OWNI 1st: OKAFO JEFF A

OWN2 DOB: 10/08/1976 / DID: 02104217636807

OWN3a 910 MAGNOLIA LN #3

MadiSOJ;l.Rolice Department

 

2/1S'/10

Message Display

F3=Exit ｆＷｾｐｲ･ｶｩｯｵｳ FS=Next F21=Print

OWN3d MADISON WI 53713

VEH Vehicle Information:

VEH2 IGCEC14Z4PEI06654 / TRUCK

VEH3 Year: 1993 / Make: CHEVROLET

VEH4 Model: CI500 / Style: PICKUP

VEH5 Color: SILVER/ALUMINUM / SILVER/ALUMINUM

TTL Title Information:

TTL1 Title Number: l0022A50026

IF10l0Sl

Unit:

026/0 -

Cf i\.ll (2.fj L

I

FiNE iTALIAN BEEF 8: SAUSAGE

"VA 'REAL VEAL"

HIT & RUN NOTES:

1.) On the morninll of WednescJay, January 13th I arrived at U-Houlot8:45 and I noticed my Food cart was hit and damaged on the front drivers side. a.) Bricks werlil knockecJ off.

b.) Front corner was crocked. c.) Front window was cracked.

d.) Inside stereo was knocked off shelf.

e.) Knifes, spoons & forks were knocked all over the Aoor. F.) Cort Was bushed bock at least 5 feet.

I looked for a note on my cart to see if the party who hit me left <10 eXplanation. No note.

2.) JO's cart was parked next to mine so I looked at their bockbumper and notiCed my carts paint Was on the rear left corner of their cart.

3.) I wasn't 100% sure what happened so since U-Haul has 24 hour surveillance camera I stopped inatJhe offlcethatafternoon. Thlil ｭ｡ｮ｡ｧｾｲ said he.nelildlild to getthlilcode. I stopped back the next day and he said he was working on the code. He told me to come back on the 17th. I did and was told he quit. I talked to a nice district manager named Josh. We both looked at footage. At 5:00 aminthemorning of January 13th a light colored piCk-up truck backed up and hit my cart sO hard it pushed it back 5 feet. I couldn't belieVIil what I was watching. Now I had prooF.

4.).1 !Jot verbal $200 estimates to Ax the cart and get A neW stereo. I called the number on the side of the JO cart and talklild to the owner (444.1590) I asked him Why no one wrote a note? He said he knew nothing of the incident and would ask. his employee who owned the pick-up truck what happened and get back to me. He never got back.

5.) Last night January, 27th I attended a food cQrt meeting at City Hall ra., by the Street Vending Coordinator, Warren Hansen and a dozen members of the board ( 261.91711)1 told them what happened. They told me to call the Police non-emergency # ASAP.

Thcmks

John Handley 334.1361

4705 Grandview Ct. McFarland, WI 608.334.1361 • www.iloveflbs.com

Mv4017 Form isn’t the one you’re looking for?

Related Documents