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Filed for Record 03/06/ - as County, WA Auditor - 201703060010 Page 5 of 8 <br />STATE OF WASH <br />` POLICE COLLISION RGTOH <br />EPORT REPORT NO. E646597 <br />1591972 CASE # <br />ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WrTNESSES ONLY) <br />NAME <br />aAnRBST. =DLE IN(TIAQ <br />ADD RESS& PHONE <br />SIX <br />D.O.A <br />MMM"YY <br />- - <br />R s ENGER❑ WITNESS❑ <br />UNIT# <br />� <br />P� <br />AIRBAG <br />AIRBAG <br />RESTR. <br />EJECT <br />H3ET <br />INJURY <br />NAnJW OF lMURIES <br />HATUREOFruuREs <br />DIAGRAM <br />Please see subsequent diagram page <br />INDICATE NORTH <br />BYARROW <br />0 <br />NARRATIVE <br />Please see subsequent narrative e s <br />E <br />ASS <br />NAME <br />MST. RRSL MCME INR AQ <br />Al O -B &PHONE 0 <br />SEX <br />D.O.B. <br />-1— <br />D <br />MMODVYYY <br />—F <br />PASSENGER WRNESS❑ <br />UNRY <br />POS <br />AIRBAG <br />RESTR. <br />EJECT <br />HELMET <br />IUSE <br />NATURE OF WURES <br />CLASS <br />NAME <br />QA9T, RRS%MM-E INMW <br />AOOFo�&PHONE S <br />SEX— <br />MMDDYYYY <br />PA85HVGER ❑ WTiNESS❑ <br />UNIT Y <br />� <br />AIRBAG <br />RESTTT. <br />EJECT <br />HELMET <br />ICL AW <br />NAnJW OF lMURIES <br />DIAGRAM <br />Please see subsequent diagram page <br />INDICATE NORTH <br />BYARROW <br />0 <br />NARRATIVE <br />Please see subsequent narrative e s <br />I CERTIFY (DECLARE) UNDER PENALTY OF PERJURY UNDER 714E LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. (RC W 9A.7208S) <br />CHARLES FERRELL 2/28/2017 <br />INVESTIGATING OFFICER'S SIGNATURE UNITOR DIST. OET DATED PLACE SIGNED <br />`PWOVWBY Mulvaney, Brian 108 01� <br />BADGE OR ID If 847 ORIR I WAWSP0000 TIMEPouCEDISPATmED 12:18 PM-nMEPOUCEARRIVED 12:23 PM <br />PART B a000-345•160 R aural PAGE FT] OF <br />