Hamey County Sheriff?s Office

David Ward, Sheriff
485 N. Court Avenue, Bums, Oregon 97720-1524
Phone (541) 573-6156 Fax (541) 573-8383

 

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DATE: 57M MG

FAX PAGES INCLUDING COVER: 
(5?05 7-1900? . . . . 9?7

PHONE REFERENCE NUMBER:

RE:  YOUR REFERENCE NUMBER:

NOTESICOMMENTS:

Mn - - 

Hamey County Shariff?a Of?ce
FORM 02062?

Id 9183 178 EBEBELSIPS: XtL-l

NUEH

 

Oregon Hunting and Hunting Related Accident Repon
chon 

msmucnows TO This rum is be mad for manning all neoldenn/incthems arming (mm hnnung,
0r huw sewed miss manned as mllows:
A. An hccidan/imidcnl Insulting Imm Ihe (Iiwlnu'gc of" mean" on how when hunliug, which causes me injury or 
Dfnuy person

   

 

 

B. An nccidum/hmdem hunting, no! illvulving the ohl firearm nr how, cams me injury or demh
m'uny person>>)

(In Any olhur hunting running from the dimlmge urn fll'cmu haw, which causes the injury
demh otany pcmou(s) Ihnh while annual] lmmlug,

  

'Lacatiun: V44 7
Conn Hm" 1M: 

Mk QM 14mm LC VMSL

 

 

   

 

 

Emma Idem: DA DE Dc 

*Typg uIC'lmInlky: Fnut Von-final DShoqter Eons". 
Yes Elm 97
nllinul'fl Ya No 
fJMIWenmn: Usher Rifle Hnudgwl Ml177lclondex inwDr'mxsbuw 
R5walver Lever MSevpi-Amo 
meWeng: Mn Model: Senna:

Sights 0m than in Pee Amlnumlin ~10hd Milhas maclury

. pljoh nir Nqufely TreeslmdUscxlijDch 

an) I'nnl'SHOOTERInroI-mulluubelow both SHOOTER nudVl

woman;
rm 4,

  

 

 

 

 

 

  

 

 

 

       
   
   
    
  
  
  

 

   
    

 

 

 

 

 

  



 . )9 State: 9
09131211191 .

Hunting Llcemc DNA

Vein;IInnfingExpcricnceg Se 
0w influence or inmxicsnu or drugs?

%Eunknuwu
Humul'h'duwlimlCel'lifled? Yes Nu minim

Slum in mm; cenifim: Certificate #2
flu>> 
If so, what section?

Omar laws violhmd'l 

'shnom in hnining lehfiud nanny? yes' 

 

      
 

         

 

 

    
    
    
   

1. him. use: if
Hunting Licgnse h, DN

(A
Yams Humng Experiment Sexfimnxe Echale
Undele uppmem influcuuc or drug's?

Dyes Um nkumvn
Nu @nknown
Camwn u:
Um mu DUuknown
Irso, :ecciuh?

DIM: Inws violmm
nhnoler involved in hunting ashvim Yes Um
Unknown

   
 

 

     
   
     
  
 
   
       
   
    
 
 

   
   
   
   
  
   
  
  
  
  

Unknown

 
  
 
  
 
   
 
   

 

check the honhehsw,

 

gnack flu: box balm

 

  

 

 
   

 

 

  

 

  
 
    
    

 

 

 

 

 

 

clothing/om Cup Tmuscrs Com/veg 
131m 7 him Orange
Rail Md
'x Brown
ulnsmamn u1u_ rfirevn 
Cmuo (um Can (uni 
Olhm'I Othcr'l

 

 

Drawing; 
0am>>

2d Manama 5m: :72 MN Xe: Luau

 

    

Wimcss Name Addms

5&4 3,3 (5 (15A 
man film \7
,Mad 
MLM

0m:
AL 1311an uy snom'lmv Amelan 
EIDove/l'igcon DElk [1an Elfimlwc birds and 
[10m DRAcwnn/(lpassum fisqniml U'l'llkay Bonr Dome: Upland Gum: Rims Gnlne

MISCELLANEOUS 
'l'opux, flph)' la: 
(Check only) ['lGonn Elwoor Unknown
. (Clwuk one only) One" Dingln DMedium Dense Unknown
s'lumy Doverwll Dnalvn Dark DUukualvu
(Cher one only) [main Usan DFag [:IUIlklluwn
lu' [1517100 CHOP- EIUuknuwn
FACTORS
Mark nmjal lama: \vifll ml x. Mark mum an A.
smly Viul mus 
Vicmumcvodlululilleoffim 
limcovcrud byslumlcr iRemlwinyplauiugufilwrmin 

     
 

  

 

 

   

 

 

who swinging all game vclliclc
,vmnn oulol'sighlofshoolcr illsingfir'camlasaclub i Mixed 
nubslkulioll
Viclim mislnkun [or ibischarge menum Won vullicle A lhy Equipmenl
Fxlenrln fie)! [mm inswurc res! ._Ricuchel
Al Aplilulle fi' m/acmss mummy iObalmclion in barrel
ggel' mugllt on fl vllile om:
_Luuding mean-n A lls: afinluxlcanwmugs
limmn Related 
_lmpl'nwcr afobslaulo mlnn-y wnnmu _,rnll while inlo n:
out o{ amnion
Droppu} firearm ,Ammnn matched il'uilurclo use 
A Camus: nl' mm: handling _Jnilnretn use surely hell/harness
Shooter and fell 7 a hacked anuw

 

Def'uclivehuw on ulrow
huw

     

 

Sullun

 

522. ,4 Ham/wk

hm . 571%" 

.. 'r'ue' 
Imam

5d Ndaama Elma v2 'fiew xv: N081