WI-96021_96859_CA_RPTS_20221128

This report has been redacted to prevent the disclosure of personally identifiable information.
DMV-349 (Rev. 1/09)THIS REPORT IS FOR THE USE OF THE DIVISION OF MOTOR VEHICLES. THE DATA IS COLLECTED FOR
STATISTICAL ANALYSIS AND SUBSEQUENT HIGHWAY SAFETY PROGRAMMING. DETERMINATIONS OF
"FAULT" ARE THE RESPONSIBILITY OF INSURERS OR OF THE STATE'S COURTS.Do not write in these spaces
Date Received by DMVDate
11/11/2022
9
8
No. of Units Involved Form 1 of 2 Supplemental Report Non-Reportable
County
MOORE
Time
10:56
Local Use/Patrol Area
22-009997 101
11
20
1
3
2
2
3
1
4 2
5
6
2
7
1
13
1426
15
16
17
0
18
19
120
33 Relation to
Roadway SurfaceL
OC
ATI
ON
1 Crash
Occurred X In CARTHAGE or Miles N S E WMunicipality
on NC 24
Use Highway Number, Street Name or Adjacent County or State Line
Highway Number, or Highway, Street. (If ramp or service road, indicate on line)Ramp or
Service Road
(R.R. Crossing #Miles 300
outside municipality
X
N S E W
BROOKLYN ST
X
At
From
X
N S E W
toward Use Highway Number, Street Name or Adjacent County or State Line
PINECREST ST Latitude
UNIT #1 X VEHICLE PEDESTRIAN HIT & RUN COMMERCIALVEHICLE
Driver MAURICE
First Middle
GOINS
Last
Address192 STONEY HILL CHURCH RD
City State ZipCARTHAGENC 28327
Same Address on Driver's
License?X Yes No
Driver's
Phone
Numbers
[phone]H
W
D.L.#52XXXXXXXXXX State NC
CDL License
DOB XX/XX/1959 34 Vision
Obstruction 0 5 035 Physical
Condition
36 D.L.
Restrictions
37 Alcohol/
Drugs Suspected 5 38 Alcohol/
Drugs Test 0 039 Results
(if known)
40 Vehicle
Seizure (DWI)
UNIT #2 X VEHICLE PEDESTRIAN HIT & RUN
Driver WILLIAM
First
FRANKLIN
Middle
MUSE
Last
Address607 MCREYNOLDS ST
City State ZipCARTHAGENC 28327
Same Address on Driver's
License?X Yes No
Driver's
Phone
Numbers
[phone]H
W
D.L.#33XXXXXXXXXX State NC
CDL License
DOB XX/XX/1953 34 Vision
Obstruction 0 1 035 Physical
Condition
36 D.L.
Restrictions
37 Alcohol/
Drugs Suspected 0 38 Alcohol/
Drugs Test 0 039 Results
(if known)
40 Vehicle
Seizure (DWI)
OTHER
28327ZipNCStateCARTHAGECity
192 STONEY HILL CHURCH RDAddress
Same as Driver?
MAURICE GOINSOwner
Same Address as Driver?
2023Plate
YearNCPlate
StateXXD6307Plate #
1FTDX1863VNA19311VIN
6132V151839Policy #
NATIONWIDE GENERAL INSURANCE
FD-743 TAD
Vehicle
Make FORD Vehicle
Year 1997 241 Vehicle
Style (Type)
42 Vehicle
Drivable X
YesNo
Insurance
Company
44 Estimated
Damage $4,000.00
28327ZipNCStateCARTHAGECity
607 MCREYNOLDS STAddress
Same as Driver?
WILLIAM FRANKLIN MUSEOwner
Same Address as Driver?
2023Plate
YearNCPlate
StateJKP3829Plate #
1FTEF25N4RNB09081VIN
6132V231525Policy #
NATIONWIDE GENERAL INSURANCE
BD-7 / FD-743 TAD
Vehicle
Make FORD Vehicle
Year 1994 241 Vehicle
Style (Type)
42 Vehicle
Drivable X
Insurance
Company
44 Estimated
Damage $4,000.00
YesNo
20 COMMERCIAL VEHICLE: Cargo, Carrier Name, Address, Source
45 Cargo Body Type Same Address as owner?
Truck
Source:
Shipping
Driver
Carrier Identification Numbers, GVWR, Axles
US DOT#ICC#Axles on Vehicle
Including Trailers
State State #IFTA#
FEI#Fleet #Gross Vehicular
Weight Rating
21 22 23 25 26 27 28 29 30 31 3224
A
B
1 1 1 Unit 1-Drv 1, Ped 1, etc. see above B M 0 2 3 2 1 3
C
D
E
F
G
H
2 1 Unit 2-Drv 2, Ped 2, etc. see above W M 0 1 3 2 1 5
see above
see above
Veh# 1 Towed To/By: KENNYS GARAGE / KENNYS GARAGE
Veh# 2 Towed To/By: KENNYS GARAGE / KENNYS GARAGE
46 Name of EMS A - MOORE COUNTY EMS
47 Injured Takenby EMS to A - MOORE REGIONAL HOSPITAL
46 Name of EMS B - NOT TRANSPORTED
47 Injured Takenby EMS to B - NOT TRANSPORTED
(Treatment Facility and City or Town)(Treatment Facility and City or Town)
ft.
Near
Unit
Longitude
Altitude
20
CD.L.
Class CD.L.Class
2
This report has been redacted to prevent the disclosure of personally identifiable information.
48 POINTS OF INTIAL
CONTACT
(Write in Codes)
Unit #
Unit #
1 2
2 2
VEHICLE INFO.
60 Authorized Speed Limit
Veh #1 Veh #2 ROADWAY INFO.
69 Road Feature
WORK ZONE RELATED
78 Work Zone Area 50
Local Use/Patrol Area:22-009997
CRASH SEQUENCE (Unit Level)
35 35
Unit #1 Unit #2 61 Estimate of Original Traveling Speed 70 Road Character 79 Work Activity
80 Work Area Marked462 Estimate of Speed at Impact 71 Road Classification
81 Crash Location63 Tire Impressions Before Impact (ft.)72 Road Surface Type
49 Vehicle Maneuver/Action
50 Non-Motorist Action
2
51 Non-Motorist Location Prior to Impact
52 Crash Sequence - First Event for this Unit 201
53 Crash Sequence - Second Event 3420
54 Crash Sequence - Third Event
55 Crash Sequence - Fourth Event
56 Most Harmful Event for this Unit 2020
57 Distance/Direction of Object Struck 22
58 Vehicle Underride/Override 33
59 Vehicle Defects 77
050
050
00
64 Distance travelled After Impact (ft.)
65 Emergency Vehicle Use
66 Post Crash Fire (if 'Yes' check block)
104104
67 School Bus - Contact Vehicle
68 School Bus - Noncontact Vehicle
1
3
3
73 Road Configuration 2
74 Access Control 2
75 Number of Lanes 2
76 Traffic Control Type 0
77 Traffic Control Oper
TRAILER INFO.Unit #1 Unit #2
082 Trailer Type 0
1st Trailer No. Axles
Width (inches)
Length (feet)
2nd Trailer No. Axles
Width (inches)
Length (feet)
Overwidth Permit #83 Unit #
Overwidth Trailer and OverwidthMobilehome
COMMERCIAL VEHICLE: Hazardous Material Involvement
Haz Mat Placard
Hazardous Cargo Released
Carrying Haz Mat
From Placard indicate:Yes
Yes
Yes
No
No
No
(Does not include fuel from fuel tank)
4-digit placard number or name from diamond or box 1-digit number from bottom of diamond
VEHICLE 1 WAS TRAVELING NORTH ON NC 24-27 AND RAN OFF THE ROAD TO THE RIGHT AND STRUCK VEHICLE 2 WHICH WAS UNOCCUPIED
AT THE TIME OF THE COLLISION. VEHICLE 1 PUSHED VEHICLE 2 104 FT UNTIL VEHICLE 2 HIT A POWER POLE AND CAME TO A FINAL RESTING
POINT. VEHICLE 1 DESTROYED MAIL BOXES AND LANDSCAPING TEMBERS DURING THE WRECK AS WELL. VEHICLE 1 CAME TO A FINAL REST IN
A FLOWER BED IN FRONT OF A RESIDENCE 605 MCREYNOLDS ST.
84 DIAGRAM
Unit # 1 was X Traveling
Parked Facing
X
N S E W
NC 24 Unit # 2 was Traveling
Parked FacingX
X
N S E W
NC 24
ADDITIONAL PROPERTY DAMAGE86 Type/ Owner MAILBOX, AND LANSCPING TIMBE
CONSTANCE JOSEPHINE
FENSTERSTOCK
Owner Address Phone [phone]
220 HEARSTONE RD, PINEHURST NC 28374 Estimated Damage $1000
WITNESSES
Name
Name
Address Phone No
Phone No.Address
TRAFFIC VIOLATION(S)REDACTED REDACTEDCharge(s) (Citation # optional)
Charge(s) (Citation # optional)
Name
Name
Officer Name
OFFICER Z K PREVATTE
Officer Number
1077
Department
CARTHAGE POLICE DEPARTMENT 06305
Date of Report
11/11/2022
State Property?
Form 1 of 2
(include pertinent unusual aspects which are not listed elsewhere on the form)
Unit
Indicate
North
85 NARRATIVE
onon
ORI
This report has been redacted to prevent the disclosure of personally identifiable information.
DMV-349 (Rev. 1/09)THIS REPORT IS FOR THE USE OF THE DIVISION OF MOTOR VEHICLES. THE DATA IS COLLECTED FOR
STATISTICAL ANALYSIS AND SUBSEQUENT HIGHWAY SAFETY PROGRAMMING. DETERMINATIONS OF
"FAULT" ARE THE RESPONSIBILITY OF INSURERS OR OF THE STATE'S COURTS.Do not write in these spaces
Date Received by DMVDate
11/11/2022
9
8
No. of Units Involved Form 2 of 2 Supplemental Report Non-Reportable
County
MOORE
Time
10:56
Local Use/Patrol Area
22-009997 10
11
1
2
3
4
5
6
7
13
14
15
16
17
18
19
12
33 Relation to
Roadway SurfaceL
OC
ATI
ON
Crash
Occurred
In or Miles N S E WMunicipality
on
Use Highway Number, Street Name or Adjacent County or State Line
Highway Number, or Highway, Street. (If ramp or service road, indicate on line)Ramp or
Service Road
(R.R. Crossing #Miles
outside municipality
N S E W
At
From N S E W
toward Use Highway Number, Street Name or Adjacent County or State Line
Latitude
UNIT #VEHICLE PEDESTRIAN HIT & RUN COMMERCIALVEHICLE
Driver
First Middle Last
Address
City State Zip
Same Address on Driver's
License?Yes No
Driver's
Phone
Numbers
H
W
D.L.#State
CDL License
DOB 34 Vision
Obstruction
35 Physical
Condition
36 D.L.
Restrictions
37 Alcohol/
Drugs Suspected
38 Alcohol/
Drugs Test
39 Results
(if known)
40 Vehicle
Seizure (DWI)
UNIT #VEHICLE PEDESTRIAN HIT & RUN
Driver
First Middle Last
Address
City State Zip
Same Address on Driver's
License?Yes No
Driver's
Phone
Numbers
H
W
D.L.#State
CDL License
DOB 34 Vision
Obstruction
35 Physical
Condition
36 D.L.
Restrictions
37 Alcohol/
Drugs Suspected
38 Alcohol/
Drugs Test
39 Results
(if known)
40 Vehicle
Seizure (DWI)
OTHER
ZipStateCity
Address
Same as Driver?
Owner
Same Address as Driver?
Plate
Year
Plate
StatePlate #
VIN
Policy #
43 TAD
Vehicle
Make
Vehicle
Year
41 Vehicle
Style (Type)
42 Vehicle
Drivable YesNo
Insurance
Company
44 Estimated
Damage
ZipStateCity
Address
Same as Driver?
Owner
Same Address as Driver?
Plate
Year
Plate
StatePlate #
VIN
Policy #
43 TAD
Vehicle
Make
Vehicle
Year
41 Vehicle
Style (Type)
42 Vehicle
Drivable
Insurance
Company
44 Estimated
Damage
YesNo
20 COMMERCIAL VEHICLE: Cargo, Carrier Name, Address, Source
45 Cargo Body Type Same Address as owner?
Truck
Source:
Shipping
Driver
Carrier Identification Numbers, GVWR, Axles
US DOT#ICC#Axles on Vehicle
Including Trailers
State State #IFTA#
FEI#Fleet #Gross Vehicular
Weight Rating
21 22 23 25 26 27 28 29 30 31 3224
A
B
Unit 1-Drv 1, Ped 1, etc. see above
C
D
E
F
G
H
Unit 2-Drv 2, Ped 2, etc. see above
see above
see above
Veh# Towed To/By:
Veh# Towed To/By:
46 Name of EMS
47 Injured Takenby EMS to
46 Name of EMS
47 Injured Takenby EMS to(Treatment Facility and City or Town)(Treatment Facility and City or Town)
ft.
Near
Unit
Longitude
Altitude
20
D.L.
Class
D.L.Class
2
This report has been redacted to prevent the disclosure of personally identifiable information.
48 POINTS OF INTIAL
CONTACT
(Write in Codes)
Unit #
Unit #
VEHICLE INFO.
60 Authorized Speed Limit
Veh #Veh #ROADWAY INFO.
69 Road Feature
WORK ZONE RELATED
78 Work Zone Area
Local Use/Patrol Area:22-009997
CRASH SEQUENCE (Unit Level)Unit #Unit #61 Estimate of Original Traveling Speed 70 Road Character 79 Work Activity
80 Work Area Marked62 Estimate of Speed at Impact 71 Road Classification
81 Crash Location63 Tire Impressions Before Impact (ft.)72 Road Surface Type
49 Vehicle Maneuver/Action
50 Non-Motorist Action
51 Non-Motorist Location Prior to Impact
52 Crash Sequence - First Event for this Unit
53 Crash Sequence - Second Event
54 Crash Sequence - Third Event
55 Crash Sequence - Fourth Event
56 Most Harmful Event for this Unit
57 Distance/Direction of Object Struck
58 Vehicle Underride/Override
59 Vehicle Defects
64 Distance travelled After Impact (ft.)
65 Emergency Vehicle Use
66 Post Crash Fire (if 'Yes' check block)
67 School Bus - Contact Vehicle
68 School Bus - Noncontact Vehicle
73 Road Configuration
74 Access Control
75 Number of Lanes
76 Traffic Control Type
77 Traffic Control Oper
TRAILER INFO.Unit #Unit #
82 Trailer Type
1st Trailer No. Axles
Width (inches)
Length (feet)
2nd Trailer No. Axles
Width (inches)
Length (feet)
Overwidth Permit #83 Unit #
Overwidth Trailer and OverwidthMobilehome
COMMERCIAL VEHICLE: Hazardous Material Involvement
Haz Mat Placard
Hazardous Cargo Released
Carrying Haz Mat
From Placard indicate:Yes
Yes
Yes
No
No
No
(Does not include fuel from fuel tank)
4-digit placard number or name from diamond or box 1-digit number from bottom of diamond
VEHICLE 1 WAS TRAVELING NORTH ON NC 24-27 AND RAN OFF THE ROAD TO THE RIGHT AND STRUCK VEHICLE 2 WHICH WAS UNOCCUPIED
AT THE TIME OF THE COLLISION. VEHICLE 1 PUSHED VEHICLE 2 104 FT UNTIL VEHICLE 2 HIT A POWER POLE AND CAME TO A FINAL RESTING
POINT. VEHICLE 1 DESTROYED MAIL BOXES AND LANDSCAPING TEMBERS DURING THE WRECK AS WELL. VEHICLE 1 CAME TO A FINAL REST IN
A FLOWER BED IN FRONT OF A RESIDENCE 605 MCREYNOLDS ST.
84 DIAGRAM
Unit # was Traveling
Parked Facing N S E W
Unit # was Traveling
Parked Facing N S E W
ADDITIONAL PROPERTY DAMAGE86 Type/ Owner MAILBOX
DOLORES BONILLO
Owner Address Phone [phone]
606 MCREYNOLDS ST, CARTHAGE NC 28327 Estimated Damage $100
WITNESSES
Name
Name
Address Phone No
Phone No.Address
TRAFFIC VIOLATION(S)Charge(s) (Citation # optional)
Charge(s) (Citation # optional)
Name
Name
Officer Name
OFFICER Z K PREVATTE
Officer Number
1077
Department
CARTHAGE POLICE DEPARTMENT 06305
Date of Report
11/11/2022
State Property?
Form 2 of 2
(include pertinent unusual aspects which are not listed elsewhere on the form)
Unit
Indicate
North
85 NARRATIVE
onon
ORI