440412041
2PETRINO4
Arkansas Uniform Motor Vehicle Collision Report
Page
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AttachmentsReport NumberVehicle - Color 2Driver - Last Name
MOTORCYCLE
Insurance - Company Name
ROBERTRED
Driver - First NameDriver - Suffix
4518 BRIDGEWATER LANEPALLSTATE3/10/1961
Driver - CityDriver - Impairment
72703
Driver - Zip Code
928907079
Driver - License NumberDriver - AddressDriver - MI
9 31 494887 03/05
Vehicle - BodyInsurance - Policy NumberDriver - StateDriver - Date of Birth
CAUCASIAN
Driver - Race
MALE
Driver - Sex
INCAPACITATING INJURY
Driver - Injury
NOT EJECTED
Driver - Ejection Code
SUNLIGHTAR
Driver - Vision Obscured
EYE PROTECTION
DL StateDriver - Safety Equipment
FAYETTEVILLENoYes
DL Endorse.
APPEARED NORMALD1HD1FR4197Y652300PETRINOARNO$2,000.00
Registration StatePlate Number
PETRINO
Owner - Last Name
ROBERT
Owner - First Name
P
Owner - MIOwner - Suffix
4518 BRIDGEWATER LANE
Owner - Address
FAYETTEVILLE
Owner - City
AR
Owner - State
72703YesNo2007
Year
M
MakeModel
2012
Plate - Year
AR
Plate - State
RI839
Plate - NumberDriver - Condition
NONE
DL ClassVehicle - Color 1
Vehicle Damage
Number of PassengersVehicle Identification Number
1
DL RestrictionsEstimated DamageBlood/Breath/Urine Results
TRAILERCAR
Undercarriage--- TOP>>
Point of Initial Contact
--- TOPUnknownWEST
Direction of Travel
GOING STRAIGHT
Vehicle Action
DISABLED
Collision Damage
ROADSIDE
First Harmful Event
OVERTURNED
First Harmful Collision With
OTHER
Contributing Factors
OTHER
Collision with fixed object
NO DEFECTS
Vehicle Defects
NO
Prior Vehicle DamageDamage LocationOwner - Zip Code
YesNoD AND D WRECKER SERVICE - MADISON
Name of Towing Service
4518 BRIDGEWATER LANE
Address Vehicle Removed To
FAYETTEVILLE
City Vehicle Removed To
AR
State Vehicle Removed To
72703
Zip Vehicle Removed To
NoYes
EMS NotifiedEMS ArrivedTransported ByHospital NameHospital CityHospital State
11
Driver - Telephone #
ROAD KINGHARLEY DAVIDSONNOT APPLICABLENO
Injury TransportedLicense PlateVehicle TowedNumber of Trailers
VIEIR
Trailer(s) Attached
ELCRDE
Air Bag
Bus (9 or more seats)Haz Mat Placard (any vehicle type)GVWR/GCWR > 10,000 lbs
CMV Qualifying Information
ToxicologyVBreath
Test Type(s)
BloodUrine
MultiPass Reqd.
H
Test Requested