| Type of Event | Accident |
| Event Date | 7/27/2012 |
| Event Day of the Week | Friday |
| Time of Event | 1350 |
| Event Time Zone | Central Daylight Time |
| Event City | Valentine |
| Event State | NEBRASKA |
| Event Country | -- |
| Zipcode of the event site | 69201 |
| Event Date Year | 2012 |
| Event Date Month | 7 |
| MidAir Collision Indicator | Yes |
| On Ground Collision occurred ? | -- |
| Event Location Latitude | 425124N |
| Event Location Longitude | 1003256W |
| Event Location Airport | Miller Field Airport |
| Event Location Nearest Airport ID | KVTN |
| Indicates whether the acc/inc occurred off or on an airport | On Airport |
| Distance from airport in statute miles | -- |
| Degrees magnetic from airport | -- |
| Airport Elevation | 2595 |
| Weather Briefing Completeness | -- |
| Investigator's weather source | Weather Observation Facility |
| Time of the weather observation | 1352 Central Daylight Time |
| Direction of event from weather observation facility (degrees) | -- |
| Weather Observation Facility ID | KVTN |
| Elevation of weather observation facility | 2595 |
| Distance of event from weather observation facility (units?) | -- |
| Time Zone of the weather observation | CDT |
| Lighting Conditions | Day |
| Lowest Ceiling Height | -- |
| Lowest Non-Ceiling Height | -- |
| Sky/Lowest/Cloud Conditions | Clear |
| Sky Condition for Lowest Ceiling | None |
| Visibility Runway Visual Range (Feet) | -- |
| Visibility Runway Visual Value (Statute Miles) | -- |
| Visibility (Statute Miles) | 10 |
| Air Temperature at event time (in degrees celsius) | 31 |
| Dew Point at event time (in degress fahrenheit) | 10 |
| Wind Direction (degrees magnetic) | 80 |
| Variable Wind Indicator | Wind direction could be determined |
| Wind Speed (knots) | 7 |
| Wind Velocity Indicator | -- |
| Wind Gust Indicator | Not Gusting |
| Wind Gust (knots) | -- |
| Altimeter Setting at event time (in. Hg) | 30.09 |
| Density Altitude (feet) | -- |
| Intensity of Precipitation | -- |
| METAR weather report | KVTN 271852Z AUTO 08007KT 10SM CLR 31/10 A3009 |
| Event Highest Injury | Fatal |
| On Ground, Fatal Injuries | -- |
| On Ground, Minor Injuries | -- |
| On Ground, Serious Injuries | -- |
| Injury Total Fatal | 1 |
| Injury Total Minor | 1 |
| Injury Total None | -- |
| Injury Total Serious | -- |
| Injury Total All | 2 |
| Investigating Agency | NTSB |
| NTSB Docket Number (internal use) | 30769 |
| NTSB Notification Source | Lincoln, NE, FAA Flight Standa |
| NTSB Notification Date | -- |
| NTSB Notification Time | -- |
| Fiche Number and/or location -used to find docket information | -- |
| Date of most recent change to record | Dec 3 2012 9:08AM |
| User who most recently changed record | bowl |
| Basic weather conditions | Visual Meteorological Cond |
| FAA District Office | -- |
Aircraft Involved |
||
|---|---|---|
Aircraft #1 |
Aircraft #2 |
|
| Aircraft Registration Number | N122JA | N766HS |
| NTSB Number | CEN12LA488A | CEN12LA488B |
| Missing Aircraft Indicator | -- | -- |
| Federal Aviation Reg. Part | Part 91: General Aviation | Part 91: General Aviation |
| Type of Flight Plan filed | None | None |
| Flight plan Was Activated? | -- | -- |
| Damage | Substantial | Substantial |
| Aircraft Fire | None | None |
| Aircraft Explosion | None | None |
| Aircraft Manufacturer's Full Name | Joseph C. Andrews, Jr. | Harold H. Smith |
| Aircraft Model | Vans | Vans |
| Aircraft Series Identifier | RV-4 | -- |
| Aircraft Serial Number | 2113 | 20509 |
| Certified Max Gross Weight | 1600 | 1750 |
| Aircraft Category | Airplane | Airplane |
| Aircraft Registration Class | -- | -- |
| Aircraft is a homebuilt? | Yes | No |
| Flight Crew Seats | 2 | 2 |
| Cabin Crew Seats | -- | -- |
| Passenger Seats | -- | -- |
| Total number of seats on the aircraft | 2 | 2 |
| Number of Engines | 1 | 1 |
| Fixed gear or retractable gear | Fixed | Fixed |
| Aircraft, Type of Last Inspection | Conditional | Conditional |
| Date of Last Inspection | May 1 2012 12:00AM | Apr 1 2012 12:00AM |
| Airframe hours since last inspection | -- | -- |
| Airframe Hours | 1013 | 1030 |
| ELT Installed | Yes | Yes |
| ELT Activated | No | No |
| ELT Aided Location of Event Site | Unknown | Unknown |
| ELT Type | -- | Unknown |
| Aircraft Owner Name | Joseph C. Andrews, Jr. | Harold H. Smith |
| Aircraft Owner Street Address | 4322 Crystal Lane Ct. | 5707 N. Ruby St. |
| Aircraft Owner City | Puyallup | Tacoma |
| Aircraft Owner State | WA | WA |
| Aircraft Owner Country | USA | USA |
| Aircraft Owner Zipcode | 98372-5293 | 98407-3019 |
| Operator is an individual? | No | No |
| Operator Name | Joseph C. Andrews, Jr. | Harold H. Smith |
| Operator Same as Owner? | Yes | Yes |
| Operator Is Doing Business As | -- | -- |
| Operator Address Same as Owner? | Yes | Yes |
| Operator Street Address | -- | -- |
| Operator City | Puyallup | Tacoma |
| Operator State | WA | WA |
| Operator Country | USA | USA |
| Operator Zip code | 98372-5293 | 98407-3019 |
| Operator Code | -- | -- |
| Owner has at least one certificate | None | None |
| Other Operator of large aircraft? | No | No |
| Certified for Part 133 or 137 Operation | -- | -- |
| Operator Certificate Number | -- | -- |
| Indicates whether an air carrier operation was scheduled or not | -- | -- |
| Indicates Domestic or International Flight | -- | -- |
| Operator carrying Pax/Cargo/Mail | -- | -- |
| Type of Flying (Per_Bus / Primary) | Personal | Personal |
| Second Pilot on Board | No | No |
| Departure Point Same as Event | No | No |
| Departure Airport Code | KMJQ | KMJQ |
| Departure City | Jackson | Jackson |
| Departure State | MN | MN |
| Departure Country | USA | USA |
| Departure Time | 1000 | 1000 |
| Departure Time Zone | CDT | CDT |
| Destination Same as Local Flt | crash at destination city | crash at destination city |
| Destination Airport Code | KVTN | KVTN |
| Destination City | Valentine | Valentine |
| Destination State | NE | NE |
| Destination Country | USA | USA |
| Specific Phase of Flight | -- | -- |
| Report sent to ICAO? | -- | -- |
| Evacuation occurred | -- | -- |
| Date of most recent change to record | Oct 4 2012 2:40PM | Oct 4 2012 2:39PM |
| User who most recently changed record | scoa | scoa |
| Since inspection or accident | Last Inspection | Time of Accident |
| Event Location Runway Number and Location | 14 | 14 |
| Runway Length | 4704 | 4704 |
| Runway Width | 75 | 75 |
| Sight Seeing flight | No | No |
| Air Medical Flight | No | No |
| Medical Flight | -- | -- |