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
17-239791
08/12/2017
1225
07 - Cannon
Serious Injury Accident
Deputy Evan Stuart
KIES ST NE/ BLAKELY DR NE
CANNON TOWNSHIP FIRE
ROCKFORD AMBULANCE
1
FORD
TAURUS
2004
ANDREW JOSEPH BARENO
16
ROCKFORD
CANNON
MI
none
E/B
2
HONDA
INSIGHT
2010
KEVIN JOHN DEWEY
55
ROCKFORD
COURTLAND
MI
NONE
W/B
YES
NATHAN ALAN BARENO
16
ROCKFORD
CANNON
MI
NONE
BRINDA KAY DEWEY
61
ROCKFORD
COURTLAND
MI
NONE
CHASE STEPHAN SHUPLE
16
ROCKFORD
COURTLAND
MI
FACIAL/HEAD INJURIES- CRITICAL CONDITION
Spectrum/BW/DT
ROCKFORD AMBULANCE
HUNTER JOHNSON KEMPF
5
ROCKFORD
CANNON
MI
NONE
Township:
UNK
UNK
701 Ball Avenue NE, Grand Rapids, MI 49503
Media Line (616) 632-6236
Traffic Crash Supplement