RE: C000356694-01

C000356694-01 consists of five pages.

The following information has been redacted from the records:

1.An individual's month and day of birth and medical information - O.C.G.A. 50-18-72(a)(20)(A).
2.A public employee's medical information - O.C.G.A. 50-18-72(a)(21)
If you have a media inquiry, please contact the Department's Public Information Office at (404) 6247597.

STATE OF GEORGIA TRAFFIC CRASH REPORT

Georgia State Patrol
Georgia Department of Public Safety
P.O. Box 1456
Atlanta. Georgia 30371-1456
Crash Nu^ber
C00035669^-01

Reporting Agency
GEORGIA DEPARTMENT OF PUBLIC SAFETY

CRASH IDENTIFIERS
County of Crash
CARROLL
Jn Scene Date/Time
09/26/2015 11:37 PM

Reporting Agency Case Number

Reporting Agency CAD Number

GSPD15CAD082611

ri City LimitsICrash Uateyiime

I Dispatched Date/Time
[Reported OaterTime
09/26/2015 11:36 PM
09/26/2015 11:37 PM
09/26/2015 11:37 PM
I Complete D8te/Time
Reason (if investigation Nol Complete)
Source
of
information
I LAW ENFORCEMENT AGENCY
09/27/2015 04:56 AM

City or Place of Crash

Cleared Scene Date/Time
09/27/2015 04:56 AM

Rnadway Descnption for Location of i

GA 1 / US 27
Distance / Direction from Crash Location L. Roadway I Roadway Cleared Dale/Time
Intersecting Roadway Description for Location of Occurrence
LJ Blocked
HOLLY SPRINGS PR
Part 01!
ghway System (Roadway Functional
Class type
IRoadway
Functional Class Detail
YES
URBAN
PRINCIPAL ARTERIAL-OTHER
ype of Shoulder
Roadway Lighting
Roadway Blkeway Facility
[Signed Bicycle Route
UNPAVED
NO LIGHTING
NONE
NOT APPLICABLE
retfic control Type et intersection
Mainline Number of Lanes at Intersection
ISide Road Number of Lanes at Intersection
STOP SIGNS ON CROSS STREET ONLY
FOUR TO SIX LANES
TWO LANES
CRASH INFORMATION
I Weather Condition
Light Condition
Roadway Surface Condition
0 Crash Pictures Taken
PARK-NOT LIGHTED
CLOUDY
WET
First Harmful Event Type
First Harmful Event Detail
COLLISION NON-FIXED OBJECT
MOTOR VEHICLE IN TRANSPORT
[Other Persons II Businesses
Motorists
Non-Motorists Injured
Fatalities
Witnesses
Total Counts Vehicles

First Harmful Event s Relation to Junction

INTERSECTION
Contributing Circumstances: Environment
NONE
Contnbuting Circumstances; Road
NONE
School Bus Related
NO
VEHICLE V01
? I V01 I MOTOR VEHICLE IN TRANSPORT

II3

Is First Harmful Event within Interchange Area

NO
Contributing Circumstances: Environment
NONE
Contributing Circumstances: Road
NONE
Work Zone Related
NO

II0

Type of Intersection
FOUR-WAY INTERSECTION
Contributing Circumstances: Environment
NONE
Contributing Circumstances: Road
NONE
Crash Location in Work Zone

IStaie (License Nu
nt
VIN
ion
IGA IBJV971Q
3N1CB51D05L575377
Year
Make
Model
ISENTRA 1.8
2005
NISSAN
Special Function of Motor Vehicle In Transport
Emergency Motor Vehicle Use
NO SPECIAL FUNCTION
NO
Owner First Name
Owner Middle Name
Owner Last Name
JEFFREY
S
FINKFN
Address
Address Other
I
Zip Code
State
1260 N FLAT ROCK RD
GA
30134-3625
Owner Phone Number
Owner Phone Number (other)
insurance Company
JInsurance Policy Number
STATE FARM
3795641A2111D
Vehicle Removal
Vehicle Towed By
Wrecker Selection Method
TOWED DUE TO DISABLING DAMAGE
RST TOWING
ROTATION
Direction of Travel Before Crash
Posted Roadway Type
Total Lanes Roadway Horizontai Alignment
Roadway Grade
SOUTHBOUND
Speed.
55
DIVIDED HIGHWAY
4STRAIGHT
HILLCREST
Trafficway Descnption
I Traffi c Control Device Type
Working Property
TWO-WAY DIVIDED POSITIVE MEDIAN BARRIER
NO CONTROLS
Roadway Descripiion for Vehicle Travel
GA 1 / US 27
Vehicle Maneuver Action (by this vehicle)
Hit S Run (by this vehicle)
Damage Extent (for this vehicle)
TURNING LEFT
NO DID NOT LEAVE SCENE
DISABLING DAMAGE
1st Sequence of Events Type (this vehicle)
1st Sequence of Events Detail (this vehicle)
COLLISION NON-FIXED OBJECT
MOTOR VEHICLE IN TRANSPORT
2nd Sequence of Events Type (this vehide)
2nd Sequence of Events Detail (this vehidej
NON-COLLISION
RAN OFF ROADWAY LEFT
3rd Sequence of Events Type (this vehicle)
3rd Sequence of Events Detail (this vehicle)
UNKNOWN
4th Sequence of Events Type (this vehide)
4(h Sequence of Events Detail (this vehide)
UNKNOWN
Most Harmful Event Type (this vehide)
Most Harmful Event Oefail (this vehicle)
COLLISION NON-FIXED OBJECT
MOTOR VEHICLE IN TRANSPORT
Contributing Circumstances 1 (this vehicle)
Contributing Circumstances 2 (this vehicle)
NONE
NONE
u
Area of Initial Impact
1V3, JU^
Most Damaged Area
./<!.:7\.
D Non Collision
|~) Non Cotlisian

Occupant Type
DRIVER
PASSENGER
PASSENGER
PASSENGER

Page 1 of 5

?Top

? Top

?Undercarriage

O Undercarriage

D Unknown

LJ Unknown
Person Name (First Middle Last Suffix)
DILLON LEWIS WALL
BENJAMIN ALAN FINKEN
ISABELLA ALISE CHINCHILLA
KYLIE HOPE LINDSEY

Injury Status
NON FATAL INJURY
NON FATAL INJURY
FATAL INJURY (K)
FATAL INJURY (K)

OFFICIAL COPY

Version 9.9.9.9

Crash Number
C0003SS694-01

Repciing Agency
GEORGIA DEPARTMENT OF PUBLIC SAFETY

Reporting Agency Case Number

MSM

Vehicle 1 ype
V02 Motor
MOTOR VEHICLE IN TRANSPORT
Year
Make
Model
2014
DODGE
CHARGER
Special Function of Motor Vehicle In Transport
NO SPECIAL FUNCTION
Owner First Name
Owner Middle Name

IVIN
I2C3CDXATXEH350973

Style
SEDAN
Emergency Motor Vehicle Use
NO
Owner Last Name

Reporting Agency CAD Number

GSPD15CAD082611

Body Type Category

PASSENGER CAR
Type of Bus Use
NOT A BUS
Owner Business (if not Person)
GA OEPT OF PUBLIC SAFETY
Address
Address Other
City
State I2ip Code
959 E. CONFEDERATE AVE
130316
ATLANTA
GA
Owner Phone Number
Owner Phone Number (other)
Insurance Company
Insurance Policy Number
STATE OF GA DOAS/RMS
TCP-401-14-14
Vehicle Removal
Vehicle Towed By
Wrecker Selection Method
TOWED DUE TO DISABLING DAMAGE
PBH
ROTATION
Direction of Travel Before Crash
Posted Roadway Type
I Total LaneslRoadway Horizontal Alignment
Roadway Grade
4
JSTRAIGHT
NORTHBOUND
Speed:
55
DIVIDED HIGHWAY
HILLCREST
Trafficway Description
Traffi c Control Device ype
Working Property
TWO-WAY DIVIDED POSITIVE MEDIAN BARRIER
NO CONTROLS
Roadway Description for Vehicle Travel
GA 1 / US 27
Vehicle Maneuver Action (by this vehicle)
Hit S Run (by this vehicle)
Damage Extent (for this vehicle)
MOVEMENTS ESSENTIALLY STRAIGHT AHEAD
NO DID NOT LEAVE SCENE
DISABLING DAMAGE
1st Sequence of Events Type (this vehicie)
1 si Sequence of Events Detail (this vehicle)
COLLISION NON-FIXED OBJECT
MOTOR VEHICLE IN TRANSPORT
2nd Sequence of Events Type (this vehicle)
2nd Sequence of Events Detail (Ihis vehicle)
NON-COLLISION
RAN OFF ROADWAY RIGHT
3rd Sequence of Events Type (this vehicle)
3rd Sequence of Events Delail (Ihis vehicle)
UNKNOWN
4th Sequence of Events Type (Ihis vehicie)
4th Sequence of Events Detail (Ihis vehicle)
UNKNOWN
Mosl Harmful Event Type (Ihis vehicle)
Mosl Harmful Event Detail (this vehicle)
COLLISION NON-FIXED OBJECT
MOTOR VEHICLE IN TRANSPORT
Contributing Circumstances 1 (this vehicle)
Contributing Circumstances 2 (this vehicle)
NONE
NONE
Area of Initial Impact
?Non Collision

y jrV
/^ A,'\

Most Damaged Area

i
!:u
V- {;>/
"t it *J*

?Top

?Top
?Undercarriage

Color
BLU

?Nan Collision

- f>\A

?Undercarriage

?Unknown
Occupant Type
DRIVER
? jI Perscr
Type
DRIVER
First Name
DILLON
Address
1390 N FLAT ROCK RD
Phone Number

D Unknown
Person Name (First Middle Last Suffi x)
ANTHONY JAMES SCOTT

Injury Status
NON FATAL INJURY

[Person Type Detail

Middle Name
LEWIS

Lest Name
WALL
Address Other

City
DOUGLASVILLE
Condition at Time of Crash
APPARENTLY NORMAL
Dnver License Number
State
Jurisdiction
Status
I VALII
057999188
1/2018
GA
02
NON-CDL DRIVER'S LICENSE
VALID LICENSE
Dnvers License Restrictions 1
Dnvers License Restrictions 2
I Drivers License
^e Restrictions 3
NONE
NONE
NONE
Dr.ver Distracted By
Dnver Vision Obstructions
NOT DISTRACTED
VISION NOT OBSCURED
Dr.v er Aclions at Time of Crash 1 (based on judgement of investigation officer)
Dnver Actions at Time of Crash 2 (based on judgement of investigation officer
FAILED TO YIELD RIGHT-OF-WAY
NO CONTRIBUTING ACTION
Onver Actions at Time of Crash 3 (based on judgement of investigation officer)
Dnver Actions at Time of Crash 4 (based on judgement of investigation officer
NO CONTRIBUTING ACTION
NO CONTRIBUTING ACTION
Motor Vehicle Seating Position- Row
Mdtor Vehicle Seating Position: Seat
I Motor Vehicle Seating Position. Other
? Seat ng Position Unknown
FRONT
LEFT
NOT APPLICABLE
Restraint Systems
SHOULDER AND LAP BELT USED
Air Bag Deployed
Ejection
DEPLOYED-FRONT
NOT EJECTED
Trapped Extrication
NOT TRAPPED
Injury Severity Level Type
Injury Severity Level Detail
r Most Obvious of Body Area Injured Dunng Crash
NON FATAL INJURY
INCAPACITATING (A)
Source of Transport to Medical Facility
EMS Agency Name
or ID
EMS Run Number
Medical Facility Transported To
Ni
EMS GROUND
AMBUCARE
4403
GRADY
AJcohoi Test Type
Law Enforcement Suspected Alcohol Use
Alcohol Tested
Alcohol Test Result
SAC
NO
TEST NOT GIVEN
Law Enforcement Suspected Drug Use
Drug Test Type
Drug Test Result
Drug Tested
NO
TEST NOT GIVEN
| Person Type
I PASSENGER
First Name
BENJAMIN
Address
1280 N FLAT ROCK RD
Phone Number
Motor Vehicle Seating Position: Row
FRONT
Page 2 of 5

Phone Number (other)

Middle Name
ALAN

Last Name
FiNKEN
TCity

Address Other

I DOUGLASVILLE

Phone Number (other)

Condition at Time of Crash

UNKNOWN
Motor Vehicle Seating Position: Seat
Motor Vehicle sealing Position: Other
RIGHT
NOT APPLICABLE
OFFICIAL COPY

D Seating Position Unknown

Version 9.9.9.9

Crash Number
C000356694-01

Restraint Systems
NONE USED - MOTOR VEHICLE OCCUPANT
Air Bag Deployed
DEPLOYED-FRONT
Trapped Extrication
TRAPPED & EXTRICATED
Injury Severity Level Type
Injury Severily Level Detail
NON FATAL INJURY
INCAPACITATING (A)
EMS Agency Name or ID
Source of Transport to Medical Facility
EMS GROUND
AMBUCARE
Law Enforcement Suspected Alcohol Use
Alcohol Test Type
NO
Law Enforcement Suspected Drug Use
Drug Test Type
NO

First Name
ISABELLA
Address
PO BOX 283
Phone Number

Reporting Agency Case Number

Reporting Agency
GEORGIA DEPARTMENT OF PUBLIC SAFETY

Middle Name
ALISE

Reporting Agency CAD Number

GSPD15CAD082611

Helmet Use
Ejection
NOT EJECTED
^^^v or Most Obvious of Body Area Injured During Crash
EMS Run Number
4400
Alcohol Tested
TEST NOT GIVEN
Drug Tested
TEST NOT GIVEN

Medical Facility Transported To

GRADY
Alcohol Test Result

BAC

6rug Test ^esuit

Last Name
CHINCHILLA
Address Olher

Phone Number (other)

Condition at Time of Crash

UNKNOWN
Motor Vehicle Seating Position: Seat
Motor Vehicle Seating Position: Other
RIGHT
NOT APPLICABLE

City
HIRAM

Motor Vehicle Seating Position: Row

? Sealing Position Unknown
SECOND
Restraint Systems
NONE USED - MOTOR VEHICLE OCCUPANT
Air Bag Deployed
Ejection
NOT DEPLOYED
NOT EJECTED
Trapped Extrication
NOT TRAPPED
Injury Severity Level Type
Injury Severity Level Detail
Pnmarv or Most Obvious of Body Area Injured During Crash
FATAL INJURY (K)
Source of Transport to Medical Facility
EMS Agency Name or ID
I Medical Facility Transported Td
EMS Run Number
NOT TRANSPORTED
Law Enforcement Suspected Alcohol Use
Alcohol Test Type
Alcohol Tested
Alcohol Test Result
NO
TEST NOT GIVEN
Law Enforcement Suspected Drug Use
Drug Test Type
Drug Tesied
Drug Test Result
NO
TEST NOT GIVEN
PASSENGER V01
I Person Type
Vehicle* [Parson Type Detail
I PASSENGER
I
V01
Middle Name
f Birth
First Name
Last Name
Age sex
KYLIE
HOPE
LINDSEY
'1998
F
Address
AddressOther
City
Zip Code
State
97 BRINKLEY CT
DALLAS
GA
30157
Phone Number
Phone Number (olher)
Condition at Time of Crash
UNKNOWN
Motor Vehicle Seating Position: Row
Molor Vehicle Sealing Position: Seat
Motor Vehicle Sealing Position: Other
? Sealing Position Unknown
SECOND
LEFT
NOT APPLICABLE
Restraint Systems
NONE USED - MOTOR VEHICLE OCCUPANT
Ait Bag Deployed
Ejection
NOT DEPLOYED
EJECTED TOTALLY
Trapped Extrication
NOT TRAPPED
Injury Severily Level Type
Injury Severity Level Detail
r Most Obvious of Body Area Injured During Crash
FATAL INJURY (K)
Source of Transport to Medical Facility
EMS Agency Name or ID
EMS Run Number
Medical Facility Transported To
EMS GROUND
WEST GA EMS
11911
ATLANTA MEDICAL
Law Enforcement Suspected Alcohol Use
Alcohol Test Result
Alcohol Test Type
Alcohol Tested
NO
TEST NOT GIVEN
Law Enforcement Suspected Drug Use
Drug Test Type
Drug Test Result
Drug Tesied
NO
TEST NOT GIVEN
.? Person
Type
DRIVER
First Name
ANTHONY
Address
959 E. CONFEDERATE AVE
hone Number

Middle Name
JAMES

Lasl Name
SCOTT
Address Other

Birth
1989
[Slate
Iga

Age Sex
26
M
ZipCode
30316

City
ATLANTA
I Condition at Time of Crash
APPARENTLY NORMAL
Driver License Number
Stale
Jurisdiction Type
Status
12019
051723010
GA
02
NON-CDL DRIVER'S LICENSE
VALID LICENSE
Dnvers License Restrictions 1
Drtvers License Restrictions 2
Drivers License Restrictions 3
NONE
NONE
NONE
Driver Distracted By
Dnver Vision Obstructions
NOT DISTRACTED
VISION NOT OBSCURED
Driver Actions at Time of Crash 1 (based on judgement of investigation officer)
Dnver Actions at Time of Crash 2 (based on judgement of invesfigetion officer)
EXCEEDED POSTED SPEED LIMIT
NO CONTRIBUTING ACTION
Driver Actions at Time of Crash 3 (based on judgement of investigation officer)
Dnver Actions at Time of Crash 4 (based on judgement of Invesfigetion officer)
NO CONTRIBUTING ACTION
NO CONTRIBUTING ACTION
Moicr Vehicle Seating Position: Row
Molor Vehicle Seating Position: Seat
I Molor Vehicle Sealing Position: Other
O Seating Position Unknown
FRONT
LEFT
NOT APPLICABLE
Restraint Systems
Helmet Use
NONE USED - MOTOR VEHICLE OCCUPANT
Air Bag Deployed
Ejection
DEPLOYED-COMBINATION
NOT EJECTED
Trapped Extncation
NOT TRAPPED
Injury Seventy Level Type
Injury Seventy Levet Detail
r Most Obvious of Body Ares Injured During Crash
NON FATAL INJURY
NON-INCAPACITATING (B)
Source of t ranspori to Medical Facility
EMS Agency Name or ID
EMS Run Number
Medical Facility Transported To
EMS GROUND
WEST GA EMS
11911
TANNER-CARROLLTON
Page 3 of 5
OFFICIAL COPY
Version 9.9.9.9
Phone Number (other)

Crash Number
C000356694-01

Repo^ing Agency
GEORGIA DEPARTMENT OF PUBLIC SAFETY

Law Enforcement Suspected Alcohol Use

NO
Law Enforcement Suspected Drug Use
NO
NARRATIVE: C000356694

Alcohol Test Type

BLOOD
Drug Test Type
BLOOD

Reporting Agency Case Number

Alcohol Tested
TEST GIVEN
Drug Tested
TEST GIVEN

Reporting Agency CAD Number

GSPD15CAD082611

Alcohol Test Result

PENDING
Drug Test Result
PENDING

SAC

Vehicle #1 was traveling south on GA 1 Vehicle #2 was traveling north on GA 1 Driver #1 was attempting to make a left turn onto Holly Springs Dr. Vehicle #1 pulled into the path
of Vehicle #2. Driver #2 attempted to avoid the crash by steenng to the right and braking, but he was not successful. Vehicle #2 struck Vehicle #1 in the right side with the front of
Vehicle #2. After impact, both vehicles left the east edge of the roadway and came to a final uncontrolled rest. The crash investigation has been turned over to SCRT for Troop D
(SCRTD-091-15).
Perm #4261B
O/R 22,003

Reporting Officer Name

BLANKENSHIP, B.L.
ID NumberRank
0604SERGEANT
Org / Unit
GSPDtPOST

Page 4 of 5

REPORTING OFFICER
Signature

APPROVING OFFICER (SUPERVISOR)

Approving Officer Name
Signature
GREENE, L.C.
ID Number
Rank
0041LIEUTENANT
Org / Unit
GSPDtCOMMA

OFFICIAL COPY

Version 9.9.9.9

Crash Number
C0Q0356694-01

Reporting Agency
GEORGIA DEPARTMENT OF PUBLIC SAFETY

Reporting Agency Case Number

Reporting Agency CAD Number

GSPD15CAD082611

DIAGRAM OF ACCIDENT

Holy Springs Rd
corv store

Store
Entry/Exit

trial red
GAi;US27NBU*E

CO R

Page 5 of 5

OFFICIAL COPY

Version 9.9.9.9