Fillable OFFICIAL MEDIA RELEASE (Kent County, Michigan)

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OFFICIAL MEDIA RELEASE (Kent County, Michigan)

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OFFICIAL MEDIA RELEASE
KENT COUNTY SHERIFF DEPARTMENT
Incident # Date: Time of Incident:
Type of Incident:
Location:
Reporting Officer:
Release Completed By:
N
UNK
Y
ALCOHOL Contributing Factor?
Make: Model: Yr:
Veh:
Make: Model: Yr:
Driver:
Driver:
Age: Age:
.
City:
Twp: Twp:
State: State:City:
Seatbelt: Y
N
YNSeatbelt:Injuries:
Injuries:
Direction of Travel:
Direction of Travel:
Hospital: Transport By:
Transport By:
Hospital:
Relatives NotifiedRelatives Notified Names Can Be Released Names Can Be Released
Vehicles
Veh:
Helicopter
Fire
Ambulance Other Police Agencies Utilities etc.
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Passengers
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Name:
Age:
City:
Twp:
State:
Seatbelt:
Injuries:
Hospital: Transport By:
Passengers
N
UNK
Y
ALCOHOL Contributing Factor?
Assisting Departments:
Clear
17-232898
07/07/2017
1642
06 - Caledonia
PI ACCIDENT
DIPADOVA
KENT COUNTY SHERRIF, CALEDONIA FIRE, THORNAPPLE TOWNSHIP
AMBULANCE, LIFE AMBULANCE
1
LEXUS
CT200H
2013
JESSICA KETO
37
CALEDONIA
MI
NONE
W/B
2
CHEVY
IMPALA
2004
EMILY JACOBS
22
CALEDONIA
MI
BACK
■
E/B
St. Mary's
THORNAPPLE TWP
YES
YES
JACKSON KETO
5
CALEDONIA
MI
CECELIA KETO
3
CALEDONIA
MI
Township:
UNK
UNK
701 Ball Avenue NE, Grand Rapids, MI 49503
Media Line (616) 632-6236
Traffic Crash Supplement
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OFFICIAL MEDIA RELEASE (Kent County, Michigan)

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Completed 20 November 2020

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