MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL

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1 This Traffic Crash Report can be purchased online at: WAS DOT PROPERTY INVOLVED IN THIS CRASH? LONG FORM SHORT FORM (Shaded Areas) UPDATE MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL TOTAL # OF VEHICLE SECTION(S) TOTAL # OF PERSON SECTION(S) TOTAL # OF NARRATIVE SECTION(S) CRASH DATE TIME OF CRASH /5/07 :5 PM CRASH IDENTIFIERS COUNTY CODE CITY CODE COUNTY OF CRASH 5 LAKE CRASH INFORMATION (CHECK IF PICTURES TAKEN) Light Condition Weather Condition Flog, Smog, Smoke Daylight 5 Dark-Not Lighted 5 Sleet/Hail/ Dusk Dark-Unknown Freezing Rain Dawn Lighting Blowing Sand, Soil Dark-Lighted Dirt Clear 7 Severe Crosswinds Cloudy Rain WITNESSES SANDRA First Harmful Event First Harmful Event within Interchange No Yes Non-Junction Intersection Intersection-Related Driveway/Alley Access Related Work Zone Related Non-Collision Overturn/Rollover Fire/Explosion Immersion Jackknife 5 Cargo/Equipment Loss or Shift Fell/Jumped From Motor Vehicle 7 Thrown or Falling Object 8 Ran int Water/Canal 9 Other Collision First Harmful Event Relation to No Yes DATE OF REPORT 0//08 TIME ON SCENE TIME CLEARED SCENE CHECK IF :57 PM : PM COMPLETED ROADWAY INFORMATION (CHOOSE ONLY OF OPTIONS) CRASH OCCURRED ON STREET, ROAD, HIGHWAY US AT FEET MILES N S E W 50 Road System Identifier Interstate U.S. State County 5 Local Turnpike/Toll Roadway Surface Condition 5 Oil Mud, Dirt, Gravel 7 Sand 8 Water (standing/moving) Dry Wet Ice/Frost Collision Non-Fixed Object 0 Pedestrian 9 Impact Attenuator/Crash Pedalcycle Cusion Railway vehicle (train, 0 Bridge Overhead Structure engine) Bridge Pier or Support Animal Bridge Rail Motor Vehicle in Culvert Transport Curb 5 Parked Motor Vehicle 5 Ditch Work Zone/Maintainance Embankment Equipment 7 Guardrail Face 7 Struck By Falling, Shifting 8 Guardrail End Cargo 9 Cable Barrier 8 Other Non-Fixed Object Contributing Circumstances: Road Junction 5 Railway Grade Crossing Entrance/Exit Ramp 5 Crossover - Related None Shared-Use of Path or Trail Work Zone (construction/ 7 Acceleration/Dceleration Lane 8 Through Roadway maintenance/utility Shoulders (none, low, soft, high) 7 Rut, Holes, Bumps Crash in Work Zone Before the First Work Zone Warning Sign Advance Warning Area Transition Area Activity Area 5 Termination Area 7 Forest Road 8 Private Roadway 9 Parking Lot REPORTING AGENCY CASE NUMBER 7MD90 PLACE OR CITY OF CRASH REASON (If Investigation NOT Complete) Type of Work Zone Lane Closure Lane Shift/Crossover Work on Shoulder or Median Intermittent or Moving Work ADDRESS PFINGSTL FANNIN 0 GOLDEN GROVE DR AT STREET ADDRESS # AT/FROM INTERSECTION WITH STREET, ROAD,HIGHWAY MORNINGSIDE DR Type of Shoulder Paved Unpaved Curb School Bus Related No Yes, School Bus Directly Involved Yes, School Bus Indirectly Involved Collision with Fixed Object 0 Concrete Other Traffic Barrier Tree (standing) Utility Pole/Light Support Traffic Sign Support 5 Traffic Signal Support Ohter Post, Pole or Support 7 Fence 8 Mailbox 9 Other Fixed Object (wall, building, tunnel, etc.) 9 Worn, Travel-Polished Surface 0 Raod Surface Condition (wet, icy, snow, slush, etc.) Obstruction in Roadway Debris Traffic Control Device Inoperative, Missing or Obscured Non-Highway Work Workers in Work Zone No Yes THE VILLAGES HSMV CRASH REPORT NUMBER CHECK IF WITHIN CITY LIMITS AT LATITUDE Type of Intersection Not at Intersection Four-Way Intersection T-Intersection Y-Intersection TIME REPORTED Manner of Collision/Impact Sideswipe, same direction 5 Sideswipe, Opposite Direction Rear to Side 7 Rear to Rear Front to Rear Front to Front Angle :5 PM First Harmful Event Location On Roadway Off Roadway Shoulder Median Gore 7 Separator 8 In Parking Lane or Zone 9 Outside Right-of-way 0 Roadside Contributing Circumstances: Environment None Weather Conditions Physical Obstruction(s) Glare :5 PM Notified By: Motorist Law Enforcement AND 5 Animal(s) in Roadway Law Enforcement in Work Zone No Officer Present Law Enforcement Vehicle Only Present FL TIME DISPATCHED LONGITUDE OR FROM MILEPOST # 5 Traffic Circle Roundabout 7 Five-Point, or More TIFFANY LEIGH BEST HOLLY DR ADDRESS FL 757 DEBORAH NON VEHICLE PROPERTY DAMAGE ADDRESS JANET NORTON 90 ROBBINS ROAD ASTATULA FL 705 VEH. # PER # PROPERTY DAMAGE - OTHER THAN VEH. EST. AMT OWNER'S (CHECK IF BUSINESS) ADDRESS VEH. # PER # PROPERTY DAMAGE - OTHER THAN VEH. EST. AMT OWNER'S (CHECK IF BUSINESS) ADDRESS HSMV 9000 S

2 Reporting Agency Case Number VEHICLE # Check if Commercial 7MD Vehicle in Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN Parked Motor Vehicle Working Vehicle GXDS89 FL 08/0/08 Registration KNAFB8507 Hit and Run YEAR MAKE MODEL STYLE COLOR DAMAGE: EST. AMOUNT No Disabling Minor Yes 00 KIA DOOR SEDAN RED - RED Functional None $7, INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due VEHICLE REMOVED BY. Rotation CENTURY-NATIONAL INSURA PGA to Damage:. Owner Request No Yes EUSTIS AMOCO. Driver. Other, Explain in OF VEHICLE OWNER (CHECK IF BUSINESS) CURRENT ADDRESS ZIP DAWN MARIE DYER 00 EUDORA ROAD APT F5 FL 757 LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent Registration VIN YEAR MAKE LENGTH AXLES LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent Registration VIN YEAR MAKE LENGTH AXLES VEHICLE TRAVELING HAZ. MAT. RELEASED No Yes MOTOR CARRIER N S E W Off-Road Unknown ON STREET, ROAD, HIGHWAY US HAZ. MAT. PLACARD NUMBER CLASS No Yes US DOT NUMBER Area of Initial Impact AT EST. SPEED 55 POSTED SPEED 55 8 Undercarriage 8 9 Overturn 9 0 Windshield 0 Trailer TOTAL LANES 5 Most Damaged Area MOTOR CARRIER ADDRESS CITY STATE PHONE NUMBER Vehicle Body Type Passenger Car Passenger Van Pickup 7 Motor Home 8 Bus Motorcycle Moped All Terrain Vehicle (ATV) Most Harmful Event Sequence of Events st rd Roadway Grade 5 Low Speed Vehicle (Sport) Utility Vehicle 7 Cargo Van (0,000 lbs (,5 kg) or less) 8 Motor Coach 9 Other Light Trucks (0,000 lbs (,5 kg) or less) 0 Medium/Heavy Trucks (more than 0,000 lbs (,5 kg)) Farm Labor Vehicle Interstate Carrier Intrastate Carrier Not in Commerce/Government Not in Commerce/Other Truck Non-Collision Overturn/Rollover Fire/Explosion Immersion Jackknife 5 Cargo/Equipment Loss or Shift Fell/Jumped From Motor Vehicle 7 Thrown or Falling Object 8 Ran into Water/Canal 9 Other Non-Collision [0- Sequence of Events only] 0 equipment Failure (blown tire, brake failure, etc.) Separation of Units Ran Off Roadway, Right Ran Off Roadway, Left Cross Median 5 Cross Centerline Downhill Runaway Trafficway Two-Way, Not Divided Two-Way, Not Divided, with a Continuous Left Turn Lane Two-Way, Divided, Unprotected (painted > feet) Median Two-Way, Divided, Positive Median Barrier 5 One-Way Trafficway Comm/Non-Commercial TRAILER TRAILER nd th Comm GVWR/GCWR Trailer Type Single Semi Trailer Tandem Semi Trailer Tank Trailer Saddle Mount/Trailer 5 Boat Trailer Utility Trailer 7 House Trailer Commercial Motor Vehicle Configuration Vehicle 0,000 lbs or less Placarded 8 Tractor/Triple for Hazardous Materials 9 Truck more than 0,000 lbs (,5 Single-Unit Truck (-axle and GVWR kg), Cannot Classify more than 0,000 lbs (,5 kg)) 0 Bus/Large van (seats for 9-5 occupants, including driver) Single-Unit Truck ( or more axles) Truck Pulling Trailer(s) 5 Truck Tractor (bobtail) Truck Tractor/Semi-Trailer 7 Truck Tractor/Double Truck 0,000 lbs (,5 kg) or less 0,00-,000 lbs (,5-,79kg) More than,000 lbs (,79kg) Not Applicable Collision with Non-Fixed Object 0 Pedestrian Pedalcycle Railway Vehicle (train, engine) Animal Motor Vehicle in Transport 5 Parked Motor Vehicle Work Zone/Maintenance Equipment 7 Struck By Falling, Shifting Cargo or Anything Set in Motion by Motor Vehicle 8 Other Non-Fixed Object Vehicle Maneuver Action Straight Ahead Stopped in Traffic Turning Left Slowing Backing 5 Negotiating a Curve 5 Turning Right Leaving Traffic Lane Changing Lanes 7 Entering Traffic Lane 8 Parked 0 Making U-Turn Overtaking/Passing This Vehicle Bus (seats for more than 5 occupants, including driver) 8 Pole Trailer 9 Towed Vehicle Cargo Body Type Intermodal 0 Auto Transport Van/Enclosed Box Container Chassis Hopper Vehicle Towing 5 Pole-Trailer Another Vehicle Cargo Tank 5 Not Applicable No Cargo 7 Flatbed (vehicle 0,000 lbs Bus 8 Dump (,5 kg) or less not 9 Concrete Mixer displaying HM placard 0 Auto Transport Garbage/Refuse Collision Fixed Object Log 9 Cable Barrier Emergency 9 Impact Attenuator/Crash Cushion 0 Concrete Traffic Barrier Vehicle Use 0 Bridge Overhead Structure Other Traffic Barrier Bridge Pier or Support Tree (standing) Bridge Rail Utility Pole/Light Support Culvert Traffic Sign Support Curb 5 Traffic Signal Support No 5 Ditch Other Post, Pole, or Support Yes Embankment 7 Fence 7 Guardrail Face 8 Mailbox 8 Guardrail End 9 Other Fixed Object (wall, building, tunnel, etc.) Traffic Control Device For Vehicle Defects Level 8 Flashing Signal 77 None Hillcrest 9 Railway Crossing Roadway Alignment No Controls Brakes Uphill Device School Zone Sign/ Tires Downhill Straight 0 Person (including Device Lights (head, 5 Sag (bottom) Curve Right Flagman, Officer, 5 Traffic Control signal, tail) Curve Left Guard, etc.) Signal Steering Special Function No Special Function 9 Ambulance Intercity Bus Stop Sign 7 Wipers Farm Vehicle 0 Fire Truck 5 Charter/Tour Bus 7 Yield Sign 9 Exhaust System of Motor Vehicle Police Farm Labor Transport Shuttle Bus 0 Body, Doors 7 Taxi School Bus 7 Farm Labor Bus Power Train 8 Military Transit/Commuter Bus Suspension VIOLATIONS Wheels Windows/ Windshield 5 Mirrors Truck Coupling Trailer Hitch/ Safety Chains 77 Other, Explain i HSMV 9000 S

3 PERSON # Driver Non-Motorist Passenger VEHICLE # CURRENT ADDRESS (Number and Street) Reporting Agency Case Number 7MD90 DAWN MARIE DYER CITY & STATE PHONE NUMBER (5) Check if Recommend Driver Re-exam 00 EUDORA ROAD APT F5 DATE OF BIRTH 08/0/9 5 DL Type A B C D/Chauffeur 5 E/Operator E/Oper-Rest 7 None Driver Distracted By Not Distracted Electronic Communication Devices (cell phone, etc. Other Electronic Device (navigation device, DVD player) DRIVER VISION OBSTRUCTIONS Vision Not Obscured Inclement Weather Parked/Stopped Vehicle Trees/Crops/Bushes SEX: DRIVERS LICENSE NUMBER Male Female D Required Endorsements Yes No No Req. Endorsement Non-Motorist Description Pedestrian Other Pedestrian (wheelchari, person in a building, skater, pedestrian conveyance, etc. Bicyclist Other Cyclist 5 Occupant of Motor Vehicle Not in Transport (parked, etc.) Occupant of a Non-Motor Vehicle Transportation Device 7 Unknown Type of Non-Motorist SUSPECTED ALCOHOL USE: No Yes Other Inside the Vehicle (explain in narrative) 5 External Distraction (outside the vehicle, explain in narrative) Texting 7 Inattentive 5 Load on Vehicle Building/Fixed Object 7 Signs/Billboards 8 Fog ALCOHOL TESTED: Test Not Given Test Refused Test Given, if Tested SOURCE OF TRANSPORT TO MEDICAL FACILITY Not Transported EMS Law Enforcement 9 Smoke 0 Glare 77 All Other, Explain in DRIVER OR PASSENGER SEAT ROW Motor Vehicle Seating Position: LOCATION: (LOC) Seat Row Left Midde Right 77 Other (explain in narrative) Front Second Third Fourth 77 Other Row None Safety Equipment 5 Lighting Helmet Not Applicable Protective Pads Used 77 Other, Explain (elbows, knees, shins, etc.) in Reflective Clothing (jacket, backpack, etc.) Other Not Applicable Sleeper Section of Truck Cab Other Enclosed Cargo Area Unenclosed Cargo Area 5 Trailing Unit Riding on Motor Vehicle Exterior (nontrailing unit) st 77 nd ADDITIONAL PASSENGERS STATE FL DRIVER Drivers Actions No Contribution Action Operated MV in Carelss or Negligent Manner Failed to Yield Right-of-Way Improper Backing Improper Turn 0 Followed too Closely Ran Red Light Drove too Fast for Conditions Ran Stop Sign 5 Improper Passing 7 Exceeded Posted Speed Wrong Side of Wrong Way 5 Failed to Keep in Proper Lane Helmet Use (HU) DOT-Compliant Motorcycle Helmet Other Helmet No Helmet Ejection (EJECT) Not Ejected Ejected, Totally Ejected, Partially Not Applicable NON-MOTORIST Non-Motorist Location At Time of Crash Intersection - Marked Crosswalk Intersection - Unmarked Crosswalk Intersection - Other Midblock - Marked Crosswalk Midblock - Marked Crosswalk 5 Travel Lane - Other Location Bicycle Lane 7 shoulder/roadside st nd ALCOHOL TEST TYPE: Blood Breath Urine 77 Other, Explain in EMS AGENCY OR ID LAKE EMS OTHER Non-Motorist Actions/Circumstances No Improper Action Dart/Dash Failure to Yield Right-of-Way Failure to Obey Traffic Signs Signals, or Officer 5 In Roadway Improperly (standing, lying, working, playing) Disabled Vehicle Related (working on, pushing, leaving/approaching) ALCOHOL TEST RESULT: PENDING COMPLETED 88 UNKNOWN EXPIRES FL 08/0/0 at Time of Crash Ran off Roadway 7 Disregarded other Traffic Sign 8 Disregarded Other Road Markings 9 Over-Correcting/Over Steering 0 Swerved or Avoided : Due to Wind, Slippery Surface, MV, Object, Non-Motorist in Roadway, etc. Operated MV in Erratic, Reckless or Agreessive Manner 77 Other Contributing Action 757 INJURY SEVERITY (INJ) None Incapacitating Possible 5 Fatal (within 0 days) Non-Incapacitating Non-Traffic Fatality Eye Protection (EP) Yes No Not Applicable Air Bag Deployed 5 Deployed-Other (knee, air belt, etc.) Not Applicable Deployed- Not Deployed Combination Deployed-Front 7 Deployed-Curtain Deployed-Side 88 Deployment Unknown 8 Sidewalk 9 Median/Crossing Island 0 Driveway Access Shared-Use Path or Trail Non-Trafficway Area 7 Entering/Exiting Parked/Standing Vehicle 8 Inattentive (talking, eating, etc) 9 Not Visible (dark clothing, no lighting, etc.) ALCOHOL/DRUG/EMS BAC SUSPECTED DRUG USE: No Yes EMS RUN NUMBER 5 rd th DRIVER OR PASSENGER Action Prior to Crash Crossing Roadway Waiting to Cross Roadway Walking/Cycling Along Roadway with Traffic (in or adjacent to travel lane) Walking/Cycling Along Roadway Against Traffic (in or adjacent to travel lane) Condition At Time of Crash Apparently Normal Asleep or Fatiuged 5 Ill (sick) or Fainted Seizure, Epilespsy, Blackout 7 Physically Impaired 8 Emotional (depression, angry, disturbed, etc.) 9 Under the Influence of Medications/Drugs/Alcohol Restraint Systems (RS) Not Applicable (non-motorist) None Used - Motor Vehicle Occupant Shoulder and Lap Belt Used Shoulder Belt Only Used 5 Lap Belt Only Used Restraint Used - Type Unknown 7 Child Restraint System - Forward Facing 8 Child Restraint System - Rear Facing 9 Booster Seat 0 Child Restraint Type Unknown 0 Improper Turn/Merge Improper Passing Wrong-Way Riding or Walking DRUG TESTED: Test Not Given Test Refused Test Given, if Tested 5 Walking/Cycling on Sidewalk In Roadway -- Other (working, playing, etc.) 7 Adjacent to Raodway (e.g., shoulder, median) 8 Going to or from School (K-) 9 Working in Trafficway (incident response) 0 None DRUG TEST TYPE: DRUG TEST RESULT: Blood Positive Urine Negative 77 Other, Pending Explain in MEDICAL FACILITY TRANSPORTED TO ORLANDO REGIONAL MEDICAL CENTER SOURCE OF TRANSPORT TO MEDICAL FACILITY Not Transported EMS Law Enforcement EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO SOURCE OF TRANSPORT TO MEDICAL FACILITY Not Transported EMS Law Enforcement EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO HSMV 9000 S

4 NARRATIVE Reporting Agency Case Number 7MD On Monday, December 5, 07 at approximately 5 hours, I responded to intersection of US HWY and Morningside Drive, Mount Dora, Florida, in reference to a vehicle crash with injuries. Upon arrival, I observed a 00 red KIA passenger car bearing Florida tad GXDS89 with front driver side damage. The incident appeared to be a single vehicle crash, with the vehicle in question striking a tree, deploying all airbags within the vehicle. The operator of the vehicle was the registered owner, Dawn M. Dyer. Dyer was unresponsive in the driver seat, did not appear to be breathing. Dyer was pulled from the vehicle where she found to not have a pulse. I applied an AED (Automatic External Defibrillator) to Dyer, and was informed by the unit a shock was required. The unit delivered a "shock" and I began CPR. After approximately one to two rounds of CPR, and a "shock" by the AED, Dyer appeared to begin breathing on her own. Lake EMS and Mount Dora Fire arrived on scene and Officer Cook and I relayed what we did to the driver, how many compression were used and how many shocks were sent by the AED. Lake EMS advised she would be air lifted to Orlando Regional Medical Center (ORMC) located in Orlando, Florida (Run#5). Witness #, Sandra Fannin, was traveling East on US HWY, when she observed the red KIA hop over the median, cross over into oncoming traffic, and strike a tree. Fannin stated the driver of vehicle that hopped the median seemed passed out behind the wheel prior to making contact with the tree. Witness #, Tiffany Best, stated she was traveling East on US HWY, when she observed the red KIA hop over the median, cross over into on-coming traffic, and strike a tree. Best stated she witnessed the vehicle hit the tree in her rear view mirror and turned around to help. Witness #, Deborah Norton, stated she was traveling East on US HWY, when she observed the red KIA hop over the median, cross over into oncoming traffic, and strike a tree. I traveled to the Dyer's apartment in Mount Dora and notified the family of the crash. At the time of this report, Dyer's condition was listed as critical, but stable. From an interview with the family, the crash was believed to be the result of a cardiac condition. ADDITIONAL PASSENGERS SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO Not Transported EMS Law Enforcement SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO Not Transported EMS Law Enforcement ADDITIONAL VIOLATIONS REPORTING OFFICER ID/BADGE # RANK OFFICER DEPARTMENT 07 OFC RICE A POLICE DEPARTME TYPE OF DEPT. POLICE DEPARTMENT (PD) HSMV 9000 S

5 DIAGRAM REPORTING AGENCY CASE NUMBER 7MD90 HSMV CRASH REPORT NUMBER HSMV 9000 S 5

6 NARRATIVE Reporting Agency Case Number 7MD The investigation revealed the initial reported injuries were not the result of the crash, but of a pre-existing medical concern. The crash also did not result in death, and has been updated to reflect only possible injuries as direct result of the crash. ADDITIONAL PASSENGERS SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO Not Transported EMS Law Enforcement SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO Not Transported EMS Law Enforcement ADDITIONAL VIOLATIONS REPORTING OFFICER ID/BADGE # RANK OFFICER DEPARTMENT TYPE OF DEPT. 07 OFC RICE A POLICE DEPARTME POLICE DEPARTMENT (PD) HSMV 9000 S