Harney County Sheriff's Office David M Ward, Sheriff 485 N, Court Avenue, Burns, Oregon 97720-1524 Phone (541) 573-6186 Fax (841) 573-8383 FACSIMILE TRANSMITTAL SHEET. \, FROM: Mymea Geib ton icon . COMPANY: DATE Os le ash FAX NUMBER: “TOTAL NO, OF PAGES INCLUDING COVER: (503) FY T= l00T. oT PrIONE NUMBE GENDERS REFERENCE NUMBER: RE YOUR REFERENCE NUMBER: NOTES/COMMENTS: SS ae Hamey Gounly Shentte fico FORM 02-0527 Td Hdta:s9 9102 ve “eM SBPBELSIDS: "ON XUSOregon Hunting and Hunting Related Accident Report Report Namber_ | LOYOLE INSTRUCTIONS TO INVESTIGATOR: ‘This form is to bo usod for teporting al weeidents/inoidents wrising from hunting, firearm or bow related activites classified as follows: "A. An nocidenveldent cesulting rom the dissharge of irearm or bow white hunting, which exuses the injury or death of any person(s) B, An accldenvincident while hunting, not i ‘of any person(s) Ay other hutoting related accident ‘Location: rolving the disohorge oF firearm or bow, which eauses the injury or death neidents resulting frou the discharge of firearm or bow, which causes the injury of death of any person(s) other than white nctanlly hunting, “County: gras los 1 if Day; 5 Day of Seayon! Description of inves: otter hale. (ond oilve dower Left oek- Laid Oxsnetship *Ghssieationof Accident: CABO Type of Casually , | esti tid: Ccas aOB “Were shooter and ‘Number of persons in parly: “+ Was injury or death self-iniicted % : 7rype of Weapon: [ shotgun Site [Handgun [TMirzltonder| JBoW —— _ygnat heton ClRevotier [Paik [beer baSem A Helge poo Miscllenoois; Caliber: 2 Draw Weight Mode —___ Serial Sigs sed CI Sm TT ition [JRelond. -Jaiany C]Paetory a Name: O'DEA Lawrence, [Address aso SHeeneccoute Red ‘Sta: Zip: 00. city: f Teepe cca po lulz *Ager Na Hinting Lense : ‘Yeats Eunting Experience: a oat in der the apparent iafluenes of ixieants or drugs? Cives Cine, Bain niet Baweation Cer es Sue in which cere ‘Carfoats FGanotaw voted: Ces No L]UiKain so, wha section? = ‘One as violated? | Shooter lavalved in unig rood wily? fe ONS pase Junknown iis ho apprapeate bax bela 2 Homemade [IFseiom) VICTIM bobo 1. he a! i Wate: iid Ades eo so Se Sally Urwin TNA ‘Years flunting Dxporence | Soe Sates CiFemale Tider tho apparent invenee oF Ttoxicants or drugs? MSE HVex LINO PgUnknone Tippy Taeation Coen? [Ves _TLINo Steen which cetifod CetfeateH *Gametaw violated: []¥es xo [JUnknown Uso, what sexton? ‘lit las violate? ‘Shooter Hnvolved int a Veuy purr DOB: 2, [iamnow {Yes TINO” Unknown Pelaiod activi? ‘Check tho appropriate box below: Coavvest_ [Trouser ‘Clothing Worn Cap] CanWest | Trousers ‘Clothing Worn ‘Cap Biave Orange Red Browi ‘Blue or Green Blue or Green Camo (uot Camo-ormnge) | ‘Attachments Zi MsTaISa 91a Pe ‘Fey eBrerestys: ‘Camo (aot Camo-ormmgs) Other ON ud PMOTelephone SL Say a ‘Aaa —Fleun, Ba ctel aa 9 Brien — 194i Sé fed Midwecl Lie ___oso_se Sarat_Milec, _ tis. ivy SS RNS ONTO anoOTanT Panto ben uck/Geese CIDove/Pigcou CJ ClFox ClGrouse Cirupbit [Non-game birds and mammal [Jeheasant Jovail LTRaccoon"Opossum PaRSqucrel Citwrkey [wid Boar LJOther Upland Gane Birds (JOther Small Game Choker WISCELTANEOUS FACTORS ‘Yopogeaphy: (Chock one on) — C]ily "paar Bee py Visibility: (Check ono only) — E}Goot ai Poor inknown, Typeofeover: (Check one only) Open Eight Medium ome Unknown, Check one ony) gSumy Eloverewst EJDawn — EiDusk Ear Unknown (Check one only) ICaim Windy GlRain Csnow Clog Clunknown Distance feom muzzle o vietim in yards 0-10 Citiso__ 51-100 itor | Tvaknown TCONTRIBUTING FACTORS: ‘Mark major factor with sm X, Mark additonal factors wih aA. eur Hunters Judgment Factors Safety Violations Miscellaneous factors Victim moved ino ie of fre _Running/waiking with loaded firearm _Fel rom watercraft ‘Vietim covered by shower Removing/placing a fireart in —imapropee power substitaton ‘who was swinging on game vehicle _Wicton oat of sight of shooter _Using Fireaem as ol ___ Mixed AmmnorInvorrect substittion __Vietim mistaken for game ___iseharge firearm itvon vebele A_Fauity Equipment eau fel rom insecure test Ricochet Skill and Aptitude Faetors Shooting from/across roadway osicueton in barrel rigger exugit on object "Horseplay” while huating oot Loading freer AL_Appirei ase of ntoxieantvdrugs —Unloutlng firearms ‘Treestund Related Factors ST iimpropet crossing of obstacle Archery Related Factors __Fall white climbing ito oe ‘out of position Dropped firearm ___-Arrow no matched to bow - —ailves to use hal Hine AR Coles handling oF Grearm —_ ~Careles baling of bowlas0w ~ Failure to we safety belvarnoss ‘Shooter sitmnbled acd fol _Cantying anocked arrow Defvotive bow or row ringing bow summus: Soe A Hacked es (aia Lego ky gabe Signature ‘Tite a ov 3/08 fd wuza:s oTae pe “Few SBSBELGTPS! “ON XS 1 Moa