Iowa State Patrol: Department of Public Safety
Minimal Crash Report:

 Case Number:  2021030633  Type:  Fatality  County:  49
 Crash Date:  12222021  Time:  0039
 Location:  7700 BLK 435TH AVE
 
 Vehicle 1 Year:  2006  Make:  FORD  Type:  500
 Towed By:  E&G TOWING
 Driver Name:  WITHHELD FOR NOTIFICATION  Age:   
 City & State of Residence:   
 
 Vehicle 2 Year:     Make:     Type:   
 Towed By:   
 Driver Name:     Age:   
 City & State of Residence:   
 
 Vehicle 3 Year:     Make:     Type:   
 Towed By:   
 Driver Name:     Age:   
 City & State of Residence:   
 
 Injury 1 Type:   
 Name:     Age:   
 City & State of Residence:   
 Seatbelt Use:     Life saved by Seatbelt:   
 Transported To:     Transported By:   
 
 Injury 2 Type:  Fatality
 Name:  PENDING NOTIFICATION  Age:   
 City & State of Residence:   
 Seatbelt Use:  No  Life saved by Seatbelt:  No
 Transported To:     Transported By:   
 
 Injury 3 Type:   
 Name:     Age:   
 City & State of Residence:   
 Seatbelt Use:     Life saved by Seatbelt:   
 Transported To:     Transported By:   
 
 Injury 4 Type:   
 Name:     Age:   
 City & State of Residence:   
 Seatbelt Use:     Life saved by Seatbelt:   
 Transported To:     Transported By:   
 
 Injury 5 Type:   
 Name:     Age:   
 City & State of Residence:   
 Seatbelt Use:     Life saved by Seatbelt:   
 Transported To:     Transported By:   
 
 Injury 6 Type:   
 Name:     Age:   
 City & State of Residence:   
 Seatbelt Use:     Life saved by Seatbelt:   
 Transported To:     Transported By:   
 
 Motor Carrier Info (IF Large truck is involved)
 Name of Carrier:   
 DOT or MCC #:   
 City & State of Carrier:     Hazmat Involved?:   
 
 Summary:  
    UNIT 1 WAS NB 7700 BLK OF 435TH AVE, THE DRIVER LOST CONTROL OF THE
VEHICLE ENTERING THE WEST DITCH, THE DRIVER WAS NOT WEARING A SEATBELT
OFFICER NAME: SMITH 109 . POST: 12
ASSISTED BY: JACKSON SO/ME,PRESTON FD/AMB, MILES FD/AMB
 
 Officer Name:  SMITH 109  Post:  12
 Assisted By:  JACKSON SO/ME,PRESTO


Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504