On October 30, 2018 a
Exhibit,Appendix
was filed
involving a dispute between
Paul John Carli,
and
Lucian Ronald,
Marieflore Poulard,
for Torts - Motor Vehicle
in the District Court of Kings County.
Preview
FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019
'
ipage1 of 4 Pages New York State Department of Motor Vehicles
Precinct POLICE ACCIDENT REPORT (NYC) 19
0 84 MV-104AN (7/11) ...
AccidentNo. Complaint
MV-2018-084-001669 Number 2018-084-003782
t DayofWeek MilitaryTirne No.of No.Injured No.Killed
NotInvestigated
at Scene LeftScenePolicePhotos20
-' Vehicles ...........__-__......__-........
__
Month Day Year .
Reconstructed Yes No
7 15 2018 SUNDAY 19:17 1 1 0
VEHICLE 1 VEHICLE 2 BICYCLIST ¤ PEDESTRIAN D OTHER PEDESTRIAN
VEHICLE1- Driver VEHICLE2- Driver
Stateof Lic. Stateof Lic.
2 LicenseID Number LicenseIDNumber 3 05 93 2 2 6 PA 21
DriverName-exactly DriverName- exactly 29
asprintedon Mcense asprintedonlicense CARLI, PAUL, JOHN
Address(includeNumber& Street) Apt.No.Address(includeNutnber& Street) ApLNo.
38 ORCHARD STREET 3B
Cityor Town State Zip Code Cityor Town State Zip Code 22
NEW YORK NY -
10022
3 Dateof Birth Sex Unlicensed No.of Public Dateof Birth Sex UnlicensedNo.of Public
Month Day Year ccupants ro e ccupants Prope
2
- Name-exactlyasprintedon registration Sex Dateof Birth
Month Day Year
Name-exactlyasprintedonregistration Sex DateorBirth
Month Day Year
Address(includeNumber& Street) Apt.No.Haz. ed Address(includeNumber& Street) Apt.No.Haz. Released23
4 Mat Mat. -
Code Code
Cityor Town State Zip Code Cityor Town State Zip Code
24
PlateNumber Stateof Reg. VehloleYear& MakeVehicleType Ins.Code PlateNumber lateof Reg. VehicleYear& Make
VehicleType ins.Code
5
Ticket/Arrest Ticket/Arrest
Number(s) Number(s)
ViolaGon Violation
Section(s) Section(s)
25
Check if involved vehicle is: Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your own
1
6 more than 95 inches wide; Omore than 95 inches wide; diagram in space #9. Number the vehicles.
V more than 34 feet long; V more than 34 feet long; RearEnd L um RightAngle
1
E
H
operated with an overweight permit;
E
operated with an overdimension permit,
H Doperated +
operated with an over."eight permit;
with an overdimension permit. + 3.
RightTum
5.
+
HeadOn
+
7.
VEHICLE 1 DAMAGE CODES VEHICLE 2 DAMAGE CODES Sideswips LertTurn RightTurnSideswipe
C Box 1 - Point of Impact 1 2 C Box 1 - Point of Impact 1 2 (same+direcNon) (opposite 1
7
L
E
Box 2 - Most Damage
Enter up to three 3
6
4
18
5
L
E
Box 2 - Most Damage
Enter up to three 3
10
4
10
5
2. + 0.
ACCIDENT DIAGRAM
4. e. 7 8. ---
more Damage Codes more Damage Codes 11 27
VehicleBy VehicleBy , 1
Towed: Towed:
To To
. DIAGRAM ATTACHED ON SUBSEQUENT PAGE
VEHICLE DAMAGE CODING:
-
1-13. SEE DIAGRAM ON RIGHT. 2 SIDE SWIPE (SAME DIR)
14. UNDERCARRIAGE 17. DEMOLISHED a is
15. TRAILER 18. NO DAMAGE 9 28
16. OVERTURNED 19. OTHER Cost of repairs
to any one vehicle
will be more
than$1000. 3
5 Unknown/Unable to Determine
a is 10 Yes No
Reference MarkerICoordinates (if available) Occurred: NEW QUEENS
Place Where AccMara BRONXQKINGS YORKO RICHMOND
Latitude/Northing: ATLANTIC
Road on which accident occurred AVENUE
j. 4 0 . 68777 (RouteNumberor StreetName)
. . 3
at 1) intersectingstreet
Longitude/Easting: (RouteNumberor StreetName)
°' 2) 2 5
N O S
HOYT STREET
-73. 9 8 701
Feet MilysQ E O W of
0ylilepost. 899teNumberor StreetName)
Nearestlatergesting
Accident Description/Officer's Notes AT
TPO BYSTANDER STATES VEHICLE 1 WAS TRAVELING IN THE LEFT LANE W/B 30
ON ATLANTIC AVE AND THE BICYCLIST TRAVELING IN THE RIGHT LANE SIDESWIPED VEHICLE 1 BY 1
COMING INTO VEHICLE l'S LANE. BYSTANDER ALSO STATES VEHICLE 1 DID NOT KNOW THAT A
COLLISION TOOK PLACE, BICYCLIST STATES VEHICLE 1 SIDESWIPED HIS BICYCLE ON THE LEFT SIDE
BY COMING INTO HIS LANE AND CAUSING HIM TO FALL CAUSING INJURIES. OFFICER DID NOT
8 9 10 11 12 13 14 15 16 17 BY TO 1 Names of all involved Date of Death Only
A A 2B 1 1 1 37 M 12 12 6 93K 7128 CARLI, PAUL , JOHN
N
V
O
D
Officer's Rank Tax ID No. NCIC No. Precinct Post/Sector
Reviewing Date/Time Reviewed
and Officer
Signature $POM
95 8 808 03030 084 SGT ANTHONY R o7/16/2018 09 : 33
Print Name
in Full DWAYNE R LEON CORREIA
FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019
PERSONS KILLED ORINJURED IN NCC.IDENT (Letter of persons.killed
desijriation rnust
or injured correspond with designation
letter on front).
A Last Name . First M.I. Last Name First M.I.
CARLI PAUL . JOHN
Address Address
38 ORCHARD .STREET. APT 3B NEW iORK NY 10022
Date of Bidh Telephone (Area Code)
. pat9 of Birth Telephone_(Area Code)
_
12 25 1980
Last Name First M.I. Last Name First M.I.
Address . . . Address
*~*- - Year· -- ----- --
Day Year M th Day
Last Name First M.I.
Highway DisL at Scene? Yes No
Address .
Dat9 of Birth Telephone (Area Code) Shield No.
.- - Month Day Year
ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD; EXPIRATION DATE (INALL CASES), AND VIN.
Vehicle No.s Vehicle No.2
Expiration Date . . .... .ExpirationDate .
.VIN . - VIN
WITNESS (Attach separate sheet, ifnecessary)
Address Phone ...
DUPLICATE COPY REQUIRED FOR:
Dept. of Motor Vehicles O Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency
(ifanyone iskilled/injured) .D.vehicle involved) . (if
a Licensed taxior limousine . (Specify)
involved)
Officeof Cornptroller Perá'onnel Safety Unit Highway Unit
(ifa Cityvehicle involved) a P.D.
(if vehicle involved)
NOTIFICATIOf(S: (Entername, address, and notified.
or relative
of friend
r.elatfor)ship If aided
person is unidentified,
list Missing
PersonSquad member who
wah notifind.
In either
pase,givedate and tirne of notification.)
PI1OPERTY DAMAGED (other than vehicles) OWNER OF IsROPERTY (includecityagency, where applicable)
IF NYPD,VEHICLE IS INVOLVED:
Police Vehicle Fifst Name
-operator's Last Name Rank . Shield No. Tax ID. No. Command
Make of Vehicle Year Type of Vehicle Plate No. Dept. Vehicle No. Assigned To What Command
Equipment in Use At Time of Accident
Siren Hom Turret Light 4-Way Flasher High-LevelWaming LightsO Traffic
Cones Headlights
ACTIONS OF POLICE VEHICLE
to Code Signal Q Complying withStationHouse Directive
Responding
O Pursuing Violator RoutinePatrol
Other (Describe)
MV-104AN(7/11) Page 2 of 4 Pages
FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019
'?age3 of 4 Pages New York State Department of Motor Vehicles
Precinct POLICE ACCIDENT REPORT (NYC) 19
O8 4 MV-104AN (7/11) .
AccidentNo. Complaint
MV-2018-084-001669 Number 201a-cet-oo31e2 AMENDED REPORT
Dayof Week MelaryTime No.of No.Injured No.Killed LeftScene
Notinvestigatedat Scene PohcePhotos 20
Month Day Year Vehicles ...........-...-.......... _
19:17 1 Reconstructed o
7 15 2018 SUNDAY 1 0
VEHICLE L.]VEHICLE ¤ BiCYCLIST ¤ PEDESTRIAN ¤ OTHER PEDESTRIAN
VEHICLE - Driver VEH1CLE- Oriver
Stateof Lic. Slateof Lic.
2 LicenseID Number LicenseIDNumber
DriverName-exactly - .
DriverName exactly
asprintedon license asprintedon license
Address(includeNumber& Street) ApLNo. Address(Inc\udeNumber& Street) Apt.No.
CityorTown State Zip Code CityorTown State Zip Code
3 D to BI h Sex UnlicensedNo.of Public Dateof Birth Sex Unlicensed No.of Public
Month Day Year Occupants P Month Day Year Occupants P
2
Name-exactlyas printedonregistration Sex Dateof Birth NamHxactly asprintedon registration Sex Dateof Birth
Month Day Year Month Day Year
'
Address(includeNumber& Street) Apt.No.Haz. Released Address(includeNumber& Street) Apt.No.Haz. Released 23
4 Mat Mat. -
I Code Code •
Cityor Town State Zip Code CityorTown State Zip Code
PlateNumber Stateof Reg. VehicleYear& MakeVehicleType Ins.Code PlateNumber Stateof Reg. VehicleYear& Make
VehicleType Ins.Code
5
Ticket/Arrest Ticket/Arrest
Number(s) Number(s)
Violation Violation
Section(s) Section(s)
Check if involved vehicle is: Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your own
-
6 Omore than 95 inches wide; more than 95 inches wide; diagrani in space #9. Number the vehicles.
1 V Omore than 34 feet long; V more than 34 feet long; RearEnd I Left Turn RightAngle RightTum HeadOn
E
H
operated with an overweight permit:
E Ooperated
poperated
0Perated with an overdimension permit·
H
with an overweight permit;
with an overdimension permit.
-+
7
+ +
7
C
VEHiCLE 1 DAMAGE CODES
Box 1 - Point of Impact 1 2
g
C
VEHICLE 2 DAMAGE CODES
Box 1 - Point of Impact 1 2
SideswI
(nan non)
LeftTum
+ RightTum Sideswipe
(opposile
26
L Box 2 - Most Damage L Box 2 - Most Damage 2. 0. 4. 6. 8. ---)•
E Enter up to three 3 4 5 E Enter up to three 3 4 5 ACCIDENT DIAGRAM ,
more Damage Codes more Damage Codes
2
Vehicle By VehicleBy 1
Towed: Towed:
To To
DIAGRAM ATTACHED ON SUBSEQUENT PAGE
VEHICLE DAMAGE CODING: a
1-13. SEE DIAGRAM ON RIGHT. 2 SIDE SWIPE ( SAME DIR)
14. UNDERCARRIAGE 17. DEMOLISHED a is I
15. TRAILER 18. NO DAMAGE 9- 28
16. OVERTURNED 19. OTHER Cost of repairs
to any one Vehicle will be rnore than
$1000. 3
5 Unknown/Unable to Determine Yes
3, in No
Reference MarkerCoordinates (if available) NEW YORKOQUEENS
Place Where Accident Occurred: BRONX¤KINGS RICHMOND
Latitude/Northing: ATLANTIC AVENUE
Road on which accident occurred
4 0 .68777 (RouteNumberor StreetName) 29
at 1) intersectingstreet
Longitude/Easting:
2) 25
N O S
HOYT STREET
-73 . 98701
°'
Feet Muns
Q E ¤ W of
(MilegonNtHiregil RouteNumberorStreetName)
|ntersecting
- 30~
Accident Description/Officer's Notes WITNESS
.
-GiiE--
P
8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all involved Date of Death only
A
N
D
Officer's Rank Tax ID No. NCIC No. Precinct Post/SectorReviewing Date/Time Reviewed
and -- Officer
Signature o7 /16/2 018 0 9 : 33
958808 03030 084 SGT ANTHONY R
Print Name
in Full DWAYNE R LEON CORREIA
FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018
NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019
Side Swipe (same dir): MV-2018-084-001669
Reporting Officer: POM DWAYNE R LEON
Reviewing Officer: SGT ANTHONY R CORREIA R"'i-"-d Date: 07/16/2018 09:33
vehicle 2
Vehicle 1
Document Filed Date
August 02, 2019
Case Filing Date
October 30, 2018
Category
Torts - Motor Vehicle
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019 ' ipage1 of 4 Pages New York State Department of Motor Vehicles Precinct POLICE ACCIDENT REPORT (NYC) 19 0 84 MV-104AN (7/11) ... AccidentNo. Complaint MV-2018-084-001669 Number 2018-084-003782 t DayofWeek MilitaryTirne No.of No.Injured No.Killed NotInvestigated at Scene LeftScenePolicePhotos20 -' Vehicles ...........__-__......__-........ __ Month Day Year . Reconstructed Yes No 7 15 2018 SUNDAY 19:17 1 1 0 VEHICLE 1 VEHICLE 2 BICYCLIST ¤ PEDESTRIAN D OTHER PEDESTRIAN VEHICLE1- Driver VEHICLE2- Driver Stateof Lic. Stateof Lic. 2 LicenseID Number LicenseIDNumber 3 05 93 2 2 6 PA 21 DriverName-exactly DriverName- exactly 29 asprintedon Mcense asprintedonlicense CARLI, PAUL, JOHN Address(includeNumber& Street) Apt.No.Address(includeNutnber& Street) ApLNo. 38 ORCHARD STREET 3B Cityor Town State Zip Code Cityor Town State Zip Code 22 NEW YORK NY - 10022 3 Dateof Birth Sex Unlicensed No.of Public Dateof Birth Sex UnlicensedNo.of Public Month Day Year ccupants ro e ccupants Prope 2 - Name-exactlyasprintedon registration Sex Dateof Birth Month Day Year Name-exactlyasprintedonregistration Sex DateorBirth Month Day Year Address(includeNumber& Street) Apt.No.Haz. ed Address(includeNumber& Street) Apt.No.Haz. Released23 4 Mat Mat. - Code Code Cityor Town State Zip Code Cityor Town State Zip Code 24 PlateNumber Stateof Reg. VehloleYear& MakeVehicleType Ins.Code PlateNumber lateof Reg. VehicleYear& Make VehicleType ins.Code 5 Ticket/Arrest Ticket/Arrest Number(s) Number(s) ViolaGon Violation Section(s) Section(s) 25 Check if involved vehicle is: Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your own 1 6 more than 95 inches wide; Omore than 95 inches wide; diagram in space #9. Number the vehicles. V more than 34 feet long; V more than 34 feet long; RearEnd L um RightAngle 1 E H operated with an overweight permit; E operated with an overdimension permit, H Doperated + operated with an over."eight permit; with an overdimension permit. + 3. RightTum 5. + HeadOn + 7. VEHICLE 1 DAMAGE CODES VEHICLE 2 DAMAGE CODES Sideswips LertTurn RightTurnSideswipe C Box 1 - Point of Impact 1 2 C Box 1 - Point of Impact 1 2 (same+direcNon) (opposite 1 7 L E Box 2 - Most Damage Enter up to three 3 6 4 18 5 L E Box 2 - Most Damage Enter up to three 3 10 4 10 5 2. + 0. ACCIDENT DIAGRAM 4. e. 7 8. --- more Damage Codes more Damage Codes 11 27 VehicleBy VehicleBy , 1 Towed: Towed: To To . DIAGRAM ATTACHED ON SUBSEQUENT PAGE VEHICLE DAMAGE CODING: - 1-13. SEE DIAGRAM ON RIGHT. 2 SIDE SWIPE (SAME DIR) 14. UNDERCARRIAGE 17. DEMOLISHED a is 15. TRAILER 18. NO DAMAGE 9 28 16. OVERTURNED 19. OTHER Cost of repairs to any one vehicle will be more than$1000. 3 5 Unknown/Unable to Determine a is 10 Yes No Reference MarkerICoordinates (if available) Occurred: NEW QUEENS Place Where AccMara BRONXQKINGS YORKO RICHMOND Latitude/Northing: ATLANTIC Road on which accident occurred AVENUE j. 4 0 . 68777 (RouteNumberor StreetName) . . 3 at 1) intersectingstreet Longitude/Easting: (RouteNumberor StreetName) °' 2) 2 5 N O S HOYT STREET -73. 9 8 701 Feet MilysQ E O W of 0ylilepost. 899teNumberor StreetName) Nearestlatergesting Accident Description/Officer's Notes AT TPO BYSTANDER STATES VEHICLE 1 WAS TRAVELING IN THE LEFT LANE W/B 30 ON ATLANTIC AVE AND THE BICYCLIST TRAVELING IN THE RIGHT LANE SIDESWIPED VEHICLE 1 BY 1 COMING INTO VEHICLE l'S LANE. BYSTANDER ALSO STATES VEHICLE 1 DID NOT KNOW THAT A COLLISION TOOK PLACE, BICYCLIST STATES VEHICLE 1 SIDESWIPED HIS BICYCLE ON THE LEFT SIDE BY COMING INTO HIS LANE AND CAUSING HIM TO FALL CAUSING INJURIES. OFFICER DID NOT 8 9 10 11 12 13 14 15 16 17 BY TO 1 Names of all involved Date of Death Only A A 2B 1 1 1 37 M 12 12 6 93K 7128 CARLI, PAUL , JOHN N V O D Officer's Rank Tax ID No. NCIC No. Precinct Post/Sector Reviewing Date/Time Reviewed and Officer Signature $POM 95 8 808 03030 084 SGT ANTHONY R o7/16/2018 09 : 33 Print Name in Full DWAYNE R LEON CORREIA FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019 PERSONS KILLED ORINJURED IN NCC.IDENT (Letter of persons.killed desijriation rnust or injured correspond with designation letter on front). A Last Name . First M.I. Last Name First M.I. CARLI PAUL . JOHN Address Address 38 ORCHARD .STREET. APT 3B NEW iORK NY 10022 Date of Bidh Telephone (Area Code) . pat9 of Birth Telephone_(Area Code) _ 12 25 1980 Last Name First M.I. Last Name First M.I. Address . . . Address *~*- - Year· -- ----- -- Day Year M th Day Last Name First M.I. Highway DisL at Scene? Yes No Address . Dat9 of Birth Telephone (Area Code) Shield No. .- - Month Day Year ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD; EXPIRATION DATE (INALL CASES), AND VIN. Vehicle No.s Vehicle No.2 Expiration Date . . .... .ExpirationDate . .VIN . - VIN WITNESS (Attach separate sheet, ifnecessary) Address Phone ... DUPLICATE COPY REQUIRED FOR: Dept. of Motor Vehicles O Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency (ifanyone iskilled/injured) .D.vehicle involved) . (if a Licensed taxior limousine . (Specify) involved) Officeof Cornptroller Perá'onnel Safety Unit Highway Unit (ifa Cityvehicle involved) a P.D. (if vehicle involved) NOTIFICATIOf(S: (Entername, address, and notified. or relative of friend r.elatfor)ship If aided person is unidentified, list Missing PersonSquad member who wah notifind. In either pase,givedate and tirne of notification.) PI1OPERTY DAMAGED (other than vehicles) OWNER OF IsROPERTY (includecityagency, where applicable) IF NYPD,VEHICLE IS INVOLVED: Police Vehicle Fifst Name -operator's Last Name Rank . Shield No. Tax ID. No. Command Make of Vehicle Year Type of Vehicle Plate No. Dept. Vehicle No. Assigned To What Command Equipment in Use At Time of Accident Siren Hom Turret Light 4-Way Flasher High-LevelWaming LightsO Traffic Cones Headlights ACTIONS OF POLICE VEHICLE to Code Signal Q Complying withStationHouse Directive Responding O Pursuing Violator RoutinePatrol Other (Describe) MV-104AN(7/11) Page 2 of 4 Pages FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019 '?age3 of 4 Pages New York State Department of Motor Vehicles Precinct POLICE ACCIDENT REPORT (NYC) 19 O8 4 MV-104AN (7/11) . AccidentNo. Complaint MV-2018-084-001669 Number 201a-cet-oo31e2 AMENDED REPORT Dayof Week MelaryTime No.of No.Injured No.Killed LeftScene Notinvestigatedat Scene PohcePhotos 20 Month Day Year Vehicles ...........-...-.......... _ 19:17 1 Reconstructed o 7 15 2018 SUNDAY 1 0 VEHICLE L.]VEHICLE ¤ BiCYCLIST ¤ PEDESTRIAN ¤ OTHER PEDESTRIAN VEHICLE - Driver VEH1CLE- Oriver Stateof Lic. Slateof Lic. 2 LicenseID Number LicenseIDNumber DriverName-exactly - . DriverName exactly asprintedon license asprintedon license Address(includeNumber& Street) ApLNo. Address(Inc\udeNumber& Street) Apt.No. CityorTown State Zip Code CityorTown State Zip Code 3 D to BI h Sex UnlicensedNo.of Public Dateof Birth Sex Unlicensed No.of Public Month Day Year Occupants P Month Day Year Occupants P 2 Name-exactlyas printedonregistration Sex Dateof Birth NamHxactly asprintedon registration Sex Dateof Birth Month Day Year Month Day Year ' Address(includeNumber& Street) Apt.No.Haz. Released Address(includeNumber& Street) Apt.No.Haz. Released 23 4 Mat Mat. - I Code Code • Cityor Town State Zip Code CityorTown State Zip Code PlateNumber Stateof Reg. VehicleYear& MakeVehicleType Ins.Code PlateNumber Stateof Reg. VehicleYear& Make VehicleType Ins.Code 5 Ticket/Arrest Ticket/Arrest Number(s) Number(s) Violation Violation Section(s) Section(s) Check if involved vehicle is: Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your own - 6 Omore than 95 inches wide; more than 95 inches wide; diagrani in space #9. Number the vehicles. 1 V Omore than 34 feet long; V more than 34 feet long; RearEnd I Left Turn RightAngle RightTum HeadOn E H operated with an overweight permit: E Ooperated poperated 0Perated with an overdimension permit· H with an overweight permit; with an overdimension permit. -+ 7 + + 7 C VEHiCLE 1 DAMAGE CODES Box 1 - Point of Impact 1 2 g C VEHICLE 2 DAMAGE CODES Box 1 - Point of Impact 1 2 SideswI (nan non) LeftTum + RightTum Sideswipe (opposile 26 L Box 2 - Most Damage L Box 2 - Most Damage 2. 0. 4. 6. 8. ---)• E Enter up to three 3 4 5 E Enter up to three 3 4 5 ACCIDENT DIAGRAM , more Damage Codes more Damage Codes 2 Vehicle By VehicleBy 1 Towed: Towed: To To DIAGRAM ATTACHED ON SUBSEQUENT PAGE VEHICLE DAMAGE CODING: a 1-13. SEE DIAGRAM ON RIGHT. 2 SIDE SWIPE ( SAME DIR) 14. UNDERCARRIAGE 17. DEMOLISHED a is I 15. TRAILER 18. NO DAMAGE 9- 28 16. OVERTURNED 19. OTHER Cost of repairs to any one Vehicle will be rnore than $1000. 3 5 Unknown/Unable to Determine Yes 3, in No Reference MarkerCoordinates (if available) NEW YORKOQUEENS Place Where Accident Occurred: BRONX¤KINGS RICHMOND Latitude/Northing: ATLANTIC AVENUE Road on which accident occurred 4 0 .68777 (RouteNumberor StreetName) 29 at 1) intersectingstreet Longitude/Easting: 2) 25 N O S HOYT STREET -73 . 98701 °' Feet Muns Q E ¤ W of (MilegonNtHiregil RouteNumberorStreetName) |ntersecting - 30~ Accident Description/Officer's Notes WITNESS . -GiiE-- P 8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all involved Date of Death only A N D Officer's Rank Tax ID No. NCIC No. Precinct Post/SectorReviewing Date/Time Reviewed and -- Officer Signature o7 /16/2 018 0 9 : 33 958808 03030 084 SGT ANTHONY R Print Name in Full DWAYNE R LEON CORREIA FILED: KINGS COUNTY CLERK 08/02/2019 11:55 AM INDEX NO. 521852/2018 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 08/02/2019 Side Swipe (same dir): MV-2018-084-001669 Reporting Officer: POM DWAYNE R LEON Reviewing Officer: SGT ANTHONY R CORREIA R"'i-"-d Date: 07/16/2018 09:33 vehicle 2 Vehicle 1