DESIREE YAGAN (315) 440-6133

PO Box 645 Dewitt, New York 13214

desireeyagan@gmail.com -Fax No. ( 315) 488-5743

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 Page 1 of 4 Pages New York State Department of Motor Vehicles
Local Codes
17-559381
POLICE ACCIDENT REPORT
MV-104A(6/04)
DX01177NGHNO D AMENDED REPORT
Accident Date Day of Week Military Time No. of No. Injured No. Killed Not Investigated at Scene f~l I Left Scene Police Photos
Month Day Year Vehicles
11 30 2017 Thursday 18:23 02 0 Accident Reconstructed D flYes Is/I No
VEHICLE 1 ] VEHICLE 2 LJBICYCLIST QPEDESTRIAN QoTHER PEDESTRIAN
VEHICLE 1- Driver State of Lie. VEHICLE 2- Driver State of Lie.
License ID Number License ID Number NY , 21
878030925
Driver Name - exactly Driver Name - exactly
as printed on license YAGAN , DESIREE S as printed on license GONZALEZCANDELARIA, W
Address (Include Number and Street) Apt. No. Address (Include Number and Street) Apt. No.
PO BOX 645 460 S MAIN ST 128
22
City or Town State Zip Code City or Town State Zip Code
DEWITT NY 132140000 N SYRACUSE NY 132120000
Date of Birth Sex No. of Occupants Public Sex Unlicensed No. of Occupants Public
Day
Month Year Month Day Year Property D
9 26 1957
Name - exactly as printed on registration Sex
. 01
Property
Damaged
Date of Birth
11 26 1977
Name - exactly as printed on registration
n Sex
01 Damaged

Month Day Month Day Year

GONZALEZCANDELARIA, W 11 26 1977

Address (Include Number and Street) Apt. No. Released Address (Include Number and Street) Apt. No. Haz. Released
D 256 THURBER ST 11
D
City or Town Zip Code City or Town State Zip Code
SYRACUSE NY 13210
D
late Number State of Reg. Vehicle Year & Make Vehicle Type Plate Number State of Reg. Vehicle Year & Make Vehicle Type Ins. Code
NY FED DBT8803 NY 2011 TOYT SUBN 639
Ticket/Arrest Ticket/Arrest
Number(s) Number(s)
Violation Violation
Section(s) Section(s)
eck if involved vehicle is: heck if involved venicle is: Circle the diagram below that describes the accident, or draw your own
I jj more than 95 inches wide; I more than 95 inches wide; diagram in space #9. Number the vehicles.
more than 34 feet long; "~j more than 34 feet long; Rear End Left .Turn Right Angle Right Turn
~ j operated with an overweight permit; "~J operated with an overweight permit;
1. S.
1 operated with an overdimension permit. ] operated with an overdimension permit. Sktettvipe
Sideswipe LsflTum RiflhtTum
VEHICLE DAMAGE CODES VEHICLE 2 DAMAGE CODES (same direction^ (oppo$Jt* direction)

Box 1 - Point of Impact

Box 2 - Most Damage
Box 1 - Point of Impact
Box 2 - Most Damage 18
, V
Enter up to three Enter up to three ACCIDENT DIAGRAM
more damage codes more damage codes
Vehicle By: Vehicle By: See the last page of the MV-104A for the
Towed To: Towed To: accident diagram.
VEHICLE DAMAGE CODING:

1-13 SEE DIAGRAM ON RIGHT.

14. UNDERCARRIAGE 17. DEMOLISHED
15. TRAILER 18. NO DAMAGE Cost of repairs to any one vehicle will be more than $1000.
16. OVERTURNED 19. OTHER
Q] Unknown/Unable to determine P] Yes (v/j No
Reference Marker Coordinates (if available) Place Where Accident Occurred:
Latitude/Northing County ONONDAGA
d] City CD Villa9e 0 Town of

4765781 Road on which accident occurred PARKING LOT 3 6 4 9 ERIE BLVD E

(Route Number or Street Name)
Longitude/Easting at 1) intersecting street
(Route Number or Street Name)
413421 or2) 025 of ERIE BVLD E
(Milepost, Nearest intersecting Route Number or Street Name)

Accident Description/Officer's notes 30

VEHICLE 2 WAS TRAVELING SOUTH THROUGH THE PARKING LOT OF SHOPPINGTOWN MALL NEAR THE RITE AID
PHARMACY. DRIVER 2 STATED SHE WAS PULLING OUT OF THE PARKING SPOT AND DID NOT SEE ANYONE WALKING
THROUGH THE PARKING LOT. DRIVER 2 STATED SHE WAS TRAVELING LESS THAN 5 MPH WHEN SHE SAW
PEDESTRIAN 1 STANDING IN FRONT OF HER VEHICLE HOLDING A NUMBER OF PACKAGES. DRIVER 2 STATED SHE
STOPPED HER VEHICLE MET EYES WITH PI AND THEN PI FELL TO THE GROUND AND
17 BY

GONZALEZCANDELARIA,

Date/Time Reviewed

12/25/2017
 Page 2 of 4 Pages New York State Department of Motor Vehicles
Local Codes
17-559381
POLICE ACCIDENT REPORT
MV-104A (6/04)
DX01177NGHNO
Day of Week Military Time Not Investigated at Scene

Thursday 18:23 Accident Reconstructed -[ I

[J VEHICLE rJBICYCLIST ] PEDESTRIAN [ JOTHER PEDESTRIAN

Circle the diagram below that describes the accident, or draw your own
diagram in space #9. Number the vehicles.

ACCIDENT DIAGRAM

VEHICLE DAMAGE CODING:

1-13 SEE DIAGRAM ON RIGHT.

14. UNDERCARRIAGE 17. DEMOLISHED
15. TRAILER 18. NO DAMAGE Cost of repairs to any one vehicle will be more than $1000.
16. OVERTURNED 19. OTHER
Unknown/Unable to determine Yes [~] N
Reference Marker Coordinates (if available) Place Where Accident Occurred:
Latitude/Northing County ON ON DAG A [j City f"J Village [j| Town of
Road on which accident occurred
(Route Number or Street Name)
Longitude/Easting at 1) intersecting street
(Route Number or Street Name)
IN Qs of
miles (Milepost, Nearest intersecting Route Number or Street Name)
Accident Description/Officer's notes 30
THE PACKAGES SHE WAS CARRYING HIT THE HOOD OF THE VEHICLE. VEHICLE 2 DID NOT. HAVE ANY MARKS OR
DAMAGE TO THE FRONT OF THE VEHICLE. PI WAS WALKING EAST THROUGH THE DIMLY LIT PARKING LOT,
BETWEEN PARKED VEHICLES WITH DARK CLOTHES ON. PI WAS UNWILLING TO GIVE A DETAILED DESCRIPTION OF
THE ACCIDENT ONLY REPEATED PROFANITY TO RESPONDERS TRYING TO HELP HER. WHEN PI WAS ASKED HER
ACCOUNT OF THE ACCIDENT SHE KEPT REPEATING THAT THIS WAS A CONSPIRACY
8 11 12 13 14 15 16 17 BY
 Page 3 of 4 New York State Department of Motor Vehicles
Local Codes
17-559381
POLICE ACCIDENT REPORT
MV-104A (6/04)
DX01177NGHNO D AMENDED REPOR1
Accident Date Day of Week Military Time No. of No. Injured No. Killed Not Investigated at Scene Left Scene Police Photos
Month Day Year Vehicles
11 30 2017 Thursday 18:23 02 Accident Reconstructed D DYeslgNo
VEHICLE £]] VEHICLE [^BICYCLIST [H|PEDESTRIAN BOTHER PEDESTRIAN

Circle the diagram below that describes the accident, or draw your own
diagram in space #9. Number the vehicles.

\r
VEHICLE DAMAGE CODING:
/I I /

a
1-13 SEE DIAGRAM ON RIGHT.
14. UNDERCARRIAGE 17. DEMOLISHED 13
15. TRAILER 18. NO DAMAGE Cost of repairs to any one vehicle will be more than $1000.
16. OVERTURNED 19. OTHER I \/ I s
[""] Unknown/Unable to determine Q Yes [jj No
Reference Marker Coordinates (if available) Place Where Accident Occurred:
Latitude/Northing County ONONDAGA
CD City CDVilla9e CDTown of
Road on which accident occurred
(Route Number or Street Name)
Longitude/Easting at 1) intersecting street
(Route Number or Street Name)
or 2) DN DS of
feet ffiiiii £] E QW (Milepost, Nearest intersecting Route Number or Street Name)
Accident Description/Officer's notes 30
THEORY. PI WAS TRANSPORTED TO UNIVERSITY HOSPITAL ER BY AMR AMBULANCE. PI'S KNEE HIGH BOOTS DID
NOT HAVE ANY MARKS OR DAMAGE TO WHERE Pi STATED SHE WAS HIT. MALL SECURITY CHECKED VIDEO
SURVEILLANCE AND NOTHING COULD BE SEEN ON THE VIDEO CAMERA THAT SWEEPS THAT PARKING LOT.

17 BY

Date/Time Reviewed

12/25/2017
22:16
 Page 4 of 4 Pages New York State Department of Motor Vehicles
Local Codes
17-559381
POLICE ACCIDENT REPORT
MV-104A(6/04)
DX01177NGHNO AMENDED REPORT

Accident Date • Day of Week Military Time No. of No. Injured No. Killed Not Investigated at Scene ( j Left Scene Police Photos
Month Day Year Vehicles
11 30 2017 Thursday 18:23 02 1 0 Accident Reconstructed [^j D DYes0N°

3649 Erie Blvd E

Shoppingtown Mai!

Rite Aid

Erie Blvd E

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in£=LTz4J"' fcEZlt±J^

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Send Result Report
MFP
02/02/2018 11:17
Firmware Version 2N4 2000.006.217 2017.05.19 [2N4_1000.004.001] [2N4_1100.001.002] [2N4_7000.006.209]
W$&$$$X WMMm^m:mmmm::

Job No.: 055955 Total Time: 0°02'22" Page: 008 8 H

Complete to S.0
District
Document: doc20180202110712

U.44*t

DESIHEE YA6AN (315) 440-6133

' PO Box 645 Dewltt, New York 13214
desireevagan@gmail.com Tax Mo. ( 315) /I8S B713

A.
No. Date and Time Destination Times Type Result Resolution/ECM
001 02/02/18 11:14 918452292586 0°02'22" FAX OK 200x100 Normal/On

[ LA75603621 ]
Send Result Report
MFP
02/02/2018 11:13
Firmware Version 2N4 2000.006.217 2017.05.19 [2N4_1000.004.001] [2N4JL100.001.002] [2N4_7000.006.209]

Job No.: 055954 Total Tine: 0°02'18" Page: 008

CfiwF\fW»eo To
Complete
Document: doc20180202110645

Ui4*t

DESIREEYAGAN (315)440-6133
PO Box 645 Dewitt, New York 13214
deslreeyagatt@gmail.com -FoK-No. (315) 488 5713

(518) 4 5 5 - 9 3

MrMitfAl

No. Date and Time Destination Times Type Result Resolution/ECM

001 02/02/18 11:11 916077239313 0°02'18" FAX OK 200x100 Normal/On

[ LA75603621 ]
Send Result Report
MFP
02/02/2018 11:10
Firmware Version 2N4 2000.006.217 2017.05.19 [2N4 1000.004.001] [2N4 1100.001.002] [2N4_7000.006.209]

Job No.: 055953 Total Time: 0°03'26" Page: 008

FAX To
Complete
Document: doc20180202110615

DESIREE YAGAN (315) 440-6133

PO BPJC 645 Dewitt, New York 13214 ^ *-Ji
desireeyagan@gmBil.com PDX Mo. (316) 4S8-S313

455,^93

No. Date and Time Destination Times Type Result Resolution/ECM

001 02/02/18 11:07 915184555693 0°03'26" FAX OK 200x100 Normal/Off

[ LA75603621 ]