This accident, involving 3 vehicles occurred on Tuesday, June 19th 2018 at approximately 1:22 pm. Injuries were reported. An officer from Bureau Sheriffs Department was present at the scene and recorded the information contained in this report.

| Occupant | Safety Belt | Air Bags | Description |
|---|---|---|---|
1 | Person 1: | ||
2 | Driver: 68 years old, Male, Possible injury: any injury reported or claimed which is not either of the above injuries. includes momentary unconsciousness, claims of injuries not evident, limping, complaint of pain, nausea, and hysteria. Seatbelt: Seat belts used Airbags: Did not deploy |

| Occupant | Safety Belt | Air Bags | Description |
|---|---|---|---|
1 | Driver: 70 years old, Male, Possible injury: any injury reported or claimed which is not either of the above injuries. includes momentary unconsciousness, claims of injuries not evident, limping, complaint of pain, nausea, and hysteria. Seatbelt: Seat belts used Airbags: Did not deploy | ||
2 | Passenger: 69 years old, Female, Possible injury: any injury reported or claimed which is not either of the above injuries. includes momentary unconsciousness, claims of injuries not evident, limping, complaint of pain, nausea, and hysteria. Seatbelt: Seat belts used Airbags: Did not deploy |

| Occupant | Safety Belt | Air Bags | Description |
|---|---|---|---|
1 | Driver: 51 years old, Male, No indication of injury. Seatbelt: Seat belts used Airbags: Did not deploy | ||
2 | Passenger: 31 years old, Male, Possible injury: any injury reported or claimed which is not either of the above injuries. includes momentary unconsciousness, claims of injuries not evident, limping, complaint of pain, nausea, and hysteria. Seatbelt: None present Airbags: Not applicable | ||
3 | Passenger: 52 years old, Male, Possible injury: any injury reported or claimed which is not either of the above injuries. includes momentary unconsciousness, claims of injuries not evident, limping, complaint of pain, nausea, and hysteria. Seatbelt: None present Airbags: Not applicable | ||
4 | Person 4: |
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