New Philadelphia Police Department
Jeffrey L. Urban-Chief of Police
122 2nd Street, SE.

New Philadelphia, Ohio. 44663
Phone: 330-343-4488 Fax: 330-343-4487
E-mail: nppd@msco.net

 

POLICE DEPARTMENT ACCIDENT REPORT

 

 

 

 

 

 

 

 

EMPLOYEE NAME: QM law,? 7 DATE: 002. 3/ gal!
ADDRESS: 075/571. 5! TIME: {2100er

SOCIAL SECURITY NUMBER:

DATE OF ACCIDENT: a alga/l TIME OF ACCIDENT: 20045 
PART OF BODY INJURED:

 

EXPLANATION OF HOW ACCIDENT OCCURRED: 74/3 9316.; grmg'g

 

 



.pa/lc'f raiser-2 rev/Id: yer-wage 4ND 7% FEAR 
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WITNESS TO ACCIDENT: ?Elam 2 LEAD

 

ADDRESS WHERE ACCIDENT OCCURRED: Qmaecx?/ 

WAS EMPLOYEE USING PROPER SAFETY EQUIPMENT (CHECK WHAT APPLIES)

 

SEAT BELT BULLETT RESISTANT VEST GLOVES
TRAFFIC CONTROL VEST (GREEN) PROTECTIVE GLASSES
EAR PROTECTTION MASK HELMET

ARE YOU SEEKING MEDICAL Na

 

A ADDRESS: 

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EMPLOYEE SIGNATUREOQQVQ fl

 

 

02I22I2011

21:15 Dover PD

 

I

330.364 .3501

CRASH REPORT

501

P.002I004

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

  

 

 

 

 

 

 

 

- CRASHSEVERITY HITISKIP pucwn TAKEN OH-cl DH-IF OTHER
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11-1470 21:41:43 31. [j 
REFORTINGAGENCY UNITS UNIT ERROR DATE OF CRASH

07902 DOVER POLICE DEPARTMENT 2 mum 2121/2011
TIME OF CRASH DAY OF WEEK CITYNILLAG HTUWNSHIP NAME IOF CITY. VILLAGE OR TOWNSHIPI LATITUDE LONGITUDE
18:58 MON CITY DOVER
'nrpE LOCATION POINTUSED
PREFIX LOCATION TYPE Lac 
901 COMMERCIAL PARKWAY
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ADDRESS CITY BUTTE ZIP-CODE
SOCIAL SECURIW DATE OF AGE SEX WORK 
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DL STATE LP STATE LP BY TRANSPORTED BY INJURED TAKEN TO
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OH 92 1:21.; I'memn
OWNER NAME WRITE DINNER ADDRESS ISTREET. CITY. STATE. ZIP-CODE
I CITY OF NEW PHILADELPHIA 122 2ND ST SE NEW PHILADELPHIA OH 44663
18_ YEAR MAKE COLOR INSURANCE COMPANY TOWING SERVICE OWNER 
I 2009 CHEVROLET IMPALA BLACK KENNEDY INS AGEN NONE (33013434433
OFFENSE CHARGED OFFENSE DESCRIPTION CITATION LDCAL com;
5:1:
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,1 OF 000 FIRST. 
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ADDRESS ISTREET. CITY STATE. ZIP CCDEI

SOCIAL SECURITY NUMBER AGE SEX HOME PHONEH WORK 
I I I330I339-1103
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OH 1 938 um 51.1.62;me

OWNER NAME IIF SAME SAMEI OWNER ADDRESS ISTREET. CITY. STATE ZIP-CODEI
STATE OF OHIO 2454 EAST HIGH AVE NEW PHILADELPHIA OH 44663
YEAR MAKE MODEL COLOR INSURANCE COMPANY TOWING SERVICE OWNER PHONEII
0 FORD CROWN VICT WHITE SELF INSURED NONE (330)339-1103
OFFENSE CHARGED OFFENSE DESCRIPTION CITATION {5 LOCAL CODE

a NAME T. FIRST. NIDOLEI HOME PHONE, DATE or BIRTH AGE SEX
SOMMERs HOLLY A (330)440-8888 0311411972 38 
ADDRESS ISTREET. CITY STATE. JU TRANSPORTED BY INJURED TAKEN To
.Izu- 
724 UNION AVE NEW PHILADELPHIA OH 44663 
NAME ILAST. FIRST. MIDDLE) HOME DATE OF BIRTH AGE sax
SMITH RONALD I330I260-3565 44 
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806 MAPLE AVE NEW PHILADELPHIA OH 44663 mm?
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COMPANY IFRQM SHIPPING PAPERS)
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DATE CRASH REPORTED TIME REC CALL DISPATCH ARRIVED CLEANED OTHER TOTAL MINUTES
2/22/2011 15:46 15:46 15:46 16:00 30 44
NAME BADGE CHECKED BY DATE REPORT FILED
PATROLMAN CHAD M. MOWRER 523 2I2212011
REPORTTAKEN BY 
I wucrauacv .I SUPPLEMENT LOCAL 
IIonu'usr IF YES 11-1470