Hp-s20a Row. 1972017 North Carolina State Highway Patrol VOLUNTARY STATEMENT Ci briver statement Pines Statement Date of Collision/Incident: ‘Time of Collision/Incident: +00 S00 Oana. DOB: 27534 oron6 Numbe Name: saeAL zi ‘Address: (Home) (_)__s Worl) s Cally TC t«~“‘C«C = Initial Traveling Speed Prior to the Collision/Incident:_ MPH Cell Pho > Begin statement here to include events that occurred before, during, and after the collision/incident: Fist puso, FT Caled 1X8 Faul Yi - Ye femmer Fale gl "St eggs fo Cale UL. NOTE | hereby certify that the information provided by me in this statement is a true and accurate representation of the facts as known to me, C18 2020w-sasa North Carolina Rew 11113 State Highway Patrol VOLUNTARY STATEMENT (Ci Driver Statement 4 Witness Statement Date of Collision/Incident:__ 4 /g//20 Time of Collision/Incident:_ $709 __ aM. P.M. Name:_phn. Welles Airdbrege. Se ee Adis! icy: effect, State: Yip. 22224 Phone Numbers: (Home) (__)__} (Work) (_)_j “iii Initial Traveling Speed Prior to the Collision/Incident: MPH Begin statement here to include events that occurred before, during, and after the collision/incident: h p wae gilt ded whan, NOTE: | hereby certify that the information provided by me in this statement is a true and accurate representation of the facts as known to me. Signature: pac: GU/2ORon tits North Carolina State Highway Patrol VOLUNTARY STATEMENT (Driver Statement] Witness Statement Date of Coliision/Incident: ‘Time of Collision/Incident: OamM.OP™M. ane Phone Number: on) mo) Initial Traveling Speed Prior to the Collision/Incident: ___ MPH. Begin statement here to include events that occurred before, during, and after the collision/ineideat: Ar aun S200 firme cath _f Seq Bnbrd bad ten bobiude rsh, up _thilly al in « a ay while NOTE: | hereby certify that the information provided by me in this statement is a true and accurate representation of the facts as known to me. Date_U~/y-24 Signature:Hp-a26a, Roy. 1113 North Carolina State Highway Patrol VOLUNTARY STATE! CO) Driver Statement ss Statement Date of Collision/Incident:_fp -/& + ‘Time of Collision/Incident: OaMOPM. wane Bee Z aber I bos Address ity: BRAT ABOD State: Phone Numbers: (Home) ( seven ede (cel) Initial Traveling Speed Prior to the Collision/Incident: AJ A-MPH Begin statement here to include events that occurred before, during, and after the collision incident Ht oamately §"Lboim pnb (¢-doIn a Py Quy Apasll rigs bth Hand eA, pes Oae aes dy “ a Vly af Ub Ly jd ae hE yh) Como” Haciap Lack hess CM 4 LE" Cty wat Cipenc lenitge LP © Joi) ss th Gc Pia Coo Dn yac d A at-tha Cash $4 ‘fy oh hofight of afat a ty Kuuiplas (Filet. day Bid) A Od Ata L. rangi rtd ad gam Usk Lokd bier 2 Sas NOTE: | hereby certiff that the information ae by me in this statement is a%rue and accurate Dae: & /K- 2020Record the Location of Occupant ‘information Based on the Diagram of the Vehicle Pei] Nae Bixee Adres Sect — [Dace Yo. | (First, MI, Last) (include City, State, and Zip Code) beret te nletng No injury Oye ax — Dye Be Deasiser | hetgey Oye Bx Beatsset | horse ays Bn eas | Epon ave ove Crenise [uncer vs Ox Bowie | chery Ove Ne cnisset Ove Dx icnssex in ite lo Tisine Dv 9 - xe haw lo Donttsea Lem STATE HIGHWAY PATROL VEHICLE TOWING AUTHORIZATION , of Tae ol Parson who gues cansont ‘Seat has Gi, Sale ip Fm PhosaiBsness Prana/Gall Phone with registration plate number ees oe Sie eb ‘Check appropiate block: i herety consent to have tis vehicle (towed) (removed) and stored by Di nerety consent to have tis vehicle maved to the shoulder oft road by the undersigned law enforcement officer ard let at his location, ‘Signature of Owner Poseassor Dave "Trosper Nana and Ragisy Number Dae